Colquitt Regional Medical Center
Organization Active NPI Family Medicine Physician · Moultrie, GA
NPI 1962850396 · NPPES record last updated Sep 4, 2025
Key facts
- NPI
- 1962850396
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- COLQUITT REGIONAL MEDICAL CENTER
- Practice address
- 3131 S Main St
Moultrie, GA 31768-6925 - Phone
- (229) 502-9769
- Fax
- (229) 985-3751
- NPI assigned
- May 26, 2016
- Organization subpart
- No
Authorized official
- Name
- James L Matney
- Title
- Ceo
- Phone
- (229) 985-3420
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 13
Member of 1
Practitioners 53
-
Justin A Baker, MD
-
Joseph B Beavers, MD
-
Melissa Cardwell, DO
-
Erin Elizabeth Dodson, D.P.M.
-
Nicholas Brian Dodson, D.P.M.
-
Thomas L Estes, M.D.,F.A.C.S.
-
Henry Alamzan Eugenio, M.D.
-
Mark A Globerman, PA-C
-
Matthew Gould, PA
-
Sanford Reginald Hawkins, M.D.
-
Amber Joy Holt, DO
-
Witemba Kabange, MD
-
Francis Kundi, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2122192 | Ga South Family Medicine Residency Clinic | Certificate of waiver | Sep 25, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Robert Hawes MD
Locations
11681 Haynes Bridge Rd
Ste 200
Alpharetta, GA 30009
Phone (404) 388-8814
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
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
- GA South Family Medicine Residency Program
- Georgia South Family Medicine
Other providers in Moultrie, GA
- Colquitt Regional Medical Center
- Colquitt Regional Medical Center
- Colquitt Regional Medical Center
- Colquitt Regional Medical Center
- Colquitt Regional Medical Center
- Colquitt Regional Medical Center
- Colquitt Regional Neurology, LLC
- Colquitt Regional OB/GYN, LLC
- Colquitt Regional Oncology LLC
- Colquitt Regional Orthopedics, LLC
All providers in Moultrie, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.