Provider Demographics
NPI:1538807375
Name:COASTAL CARE MD, LLC
Entity type:Organization
Organization Name:COASTAL CARE MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-598-6322
Mailing Address - Street 1:4 SKIDAWAY VILLAGE WALK STE B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-2962
Mailing Address - Country:US
Mailing Address - Phone:912-598-6322
Mailing Address - Fax:912-809-4995
Practice Address - Street 1:4 SKIDAWAY VILLAGE WALK STE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411-2962
Practice Address - Country:US
Practice Address - Phone:912-598-6322
Practice Address - Fax:912-809-4995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL CARE MD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care