Provider Demographics
NPI:1548891575
Name:COASTAL ACUPUNCTURE
Entity type:Organization
Organization Name:COASTAL ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:706-938-0672
Mailing Address - Street 1:405 W MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3560
Mailing Address - Country:US
Mailing Address - Phone:706-938-0672
Mailing Address - Fax:
Practice Address - Street 1:405 W MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3560
Practice Address - Country:US
Practice Address - Phone:706-938-0672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL ACUPUNCTURE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty