Organization · Type 2 NPI

Colquitt Regional Medical Center

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Moultrie, GA

NPI number 1124155965 Active

Practice location

449 31st Ave SE
Moultrie, GA 31768-7733

Call (229) 891-9333 Map

Mailing address

3131 S Main St
Moultrie, GA 31768-6925

Specialties and licenses

Taxonomy	Code	License
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary	261QE0700X	035296 (GA)

End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...

Other end-stage renal disease (esrd) treatment clinic/center providers in Moultrie

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See all in Moultrie →

NPI record

NPI: 1124155965
Entity type: Organization (Type 2)
Issued: Feb 28, 2007
Last updated: Oct 28, 2026
Status: Active
Subpart: Yes of Colquitt Regional Medical Center

Other names

<unavail>
Colquitt Regional Medical Center Dialysis · doing business as

Authorized official

Mr. Jim Matney
President/ceo
(229) 985-3420

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1124155965

Colquitt Regional Medical Center's National Provider Identifier is 1124155965, issued on Feb 28, 2007. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Moultrie, GA. The record was last updated on Oct 28, 2026.