Provider Demographics
NPI:1902211642
Name:COLQUITT REGIONAL EMERGENCY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:COLQUITT REGIONAL EMERGENCY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHAMB
Authorized Official - Middle Name:
Authorized Official - Last Name:PUROHIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-502-9703
Mailing Address - Street 1:PO BOX 3697
Mailing Address - Street 2:3131 S. MAIN ST
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-3697
Mailing Address - Country:US
Mailing Address - Phone:800-579-7777
Mailing Address - Fax:
Practice Address - Street 1:3131 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6925
Practice Address - Country:US
Practice Address - Phone:229-336-4621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty