Colquitt Regional Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

COLQUITT REGIONAL DERMATOLOGY, LLC

Practice address

760 26TH Ave SE
Moultrie, GA 31768-6799

Phone

(229) 502-9710

NPI assigned

Jun 5, 2014

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

COLQUITT REGIONAL MEDICAL, INCAs reported in NPPES

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

Authorized official

Name

Amanda L Roberts

Title

Provider Enrollment Coordinator

Phone

(229) 891-9131

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Rhonda Bedell, MD

  • Internal Medicine Physician
  • Moultrie, GA
  • NPI 1346388410
  NPD (past)

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

{
    "created_epoch": "1401926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1649683897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 26TH AVE SE",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686799",
            "telephone_number": "229-502-9710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 26TH AVE SE",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686799",
            "telephone_number": "229-502-9710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLQUITT REGIONAL DERMATOLOGY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLQUITT REGIONAL MEDICAL, INC",
        "enumeration_date": "2014-06-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT COORDINATOR",
        "authorized_official_telephone_number": "229-891-9131"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.