Provider Demographics
NPI:1730393455
Name:COASTAL DERMATOLOGY
Entity type:Organization
Organization Name:COASTAL DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-562-7092
Mailing Address - Street 1:400 COMMERCIAL CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3648
Mailing Address - Country:US
Mailing Address - Phone:912-352-3535
Mailing Address - Fax:912-352-3485
Practice Address - Street 1:400 COMMERCIAL CT
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3648
Practice Address - Country:US
Practice Address - Phone:912-352-3535
Practice Address - Fax:912-352-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADF6062OtherRAILROAD MEDICARE
GAGRP7436Medicare PIN
GAGRP7436Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER