NPIMap

Organization Active NPI

Colquitt Family Care, Inc.

  • Clinic/Center
  • Moultrie, GA
National Provider Identifier
1215088174
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
043008 Issued in GA
Legal business name
COLQUITT FAMILY CARE, INC.
Practice address
2801 S Main St
Moultrie, GA 31768-6908
Phone
(229) 891-2170
NPI assigned
Jan 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Roland Manoutcheher Brown, M.D.NPI 1295818581
Title
Owner
Phone
(229) 891-2170

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 043008 GA Primary

Addresses

Primary practice location

2801 S Main St
Moultrie, GA 31768-6908

Mailing address

2801 S Main St
Moultrie, GA 31768-6908
Phone (229) 891-2170

Other identifiers 1

IdentifierTypeStateIssuer
85001900GMedicaidGA

National Provider Directory

National Provider Directory

Locations

2801 S Main St
Moultrie, GA 31768
Phone (229) 891-2170

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215088174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686908",
            "telephone_number": "229-891-2170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686908",
            "telephone_number": "229-891-2170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLQUITT FAMILY CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_middle_name": "MANOUTCHEHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-891-2170",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "043008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "85001900G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moultrie, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.