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MOULTRIE CENTER FOR ADULT AND PEDIATRIC HEALTHCARE PC NPI 1477620912


NPI Information

NPI: 1477620912
Provider Name: MOULTRIE CENTER FOR ADULT AND PEDIATRIC HEALTHCARE, PC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 11D2250640

Address:
760 26TH AVE SE
MOULTRIE, GA
ZIP 31768
Phone: (229) 985-6700
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MOULTRIE CENTER FOR ADULT AND PEDIATRIC HEALTHCARE, PC is a family medicine in Moultrie, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. MOULTRIE CENTER FOR ADULT AND PEDIATRIC HEALTHCARE, PC NPI is 1477620912. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

760 26TH AVE SE
MOULTRIE, GA
ZIP 31768-799
Phone: (229) 985-6700
Fax: (229) 891-2382

The provider's authorized official is Rhonda R. Smith .
The authorized official title is Practice Manager and has the following contact phone number (229) 985-6700.

The CLIA number assigned to this NPI record is 11D2250640 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/29/2006 and was last updated on 12/7/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1GRP4399MEDICARE ID-TYPE UNSPECIFIEDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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