NPIMap

Organization Active NPI

Colquitt Regional Medical Center

Doing business as GA South Family Medicine Residency Program

  • Family Medicine Physician
  • Moultrie, GA
National Provider Identifier
1962850396
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COLQUITT REGIONAL MEDICAL CENTER
Doing business as
GA South Family Medicine Residency Program
Georgia South Family Medicine
Practice address
3131 S Main St
Moultrie, GA 31768-6925
Phone
(229) 502-9769
Fax
(229) 985-3751
NPI assigned
May 26, 2016
Last updated
Sep 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Authorized official

Name
James L Matney
Title
Ceo
Phone
(229) 985-3420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3131 S Main St
Moultrie, GA 31768-6925

Mailing address

PO Box 2876
Moultrie, GA 31776-2876
Phone (229) 891-9131

Other names 2

  • GA South Family Medicine Residency Program Doing business as
  • Georgia South Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040415000368 GA Part B Supplier - Clinic/Group Practice 6204821796 Receives reassigned benefits from 77 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Moultrie, GA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2122192Ga South Family Medicine Residency Clinic3131 S Main Street, BLDG J, Moultrie, GA 31768Certificate of waiverSep 25, 2027

National Provider Directory

National Provider Directory
Tax ID family
Colquitt Regional Med C14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

11681 Haynes Bridge Rd
Ste 200
Alpharetta, GA 30009
Phone (770) 475-3146

Practitioners & affiliated clinicians

Practitioners 54

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.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1464220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756944000000",
    "number": "1962850396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2876",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317762876",
            "telephone_number": "229-891-9131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686925",
            "telephone_number": "229-502-9769",
            "fax_number": "229-985-3751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLQUITT REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-26",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A",
        "authorized_official_last_name": "MATNEY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-985-3420"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GA South Family Medicine Residency Program",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Georgia South Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.