Provider Demographics
NPI:1063460004
Name:COASTAL ANESTHESIA & PAIN RELIEF SPECIALISTS
Entity Type:Organization
Organization Name:COASTAL ANESTHESIA & PAIN RELIEF SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-756-3004
Mailing Address - Street 1:PO BOX 235022
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-5022
Mailing Address - Country:US
Mailing Address - Phone:334-386-2053
Mailing Address - Fax:334-244-1830
Practice Address - Street 1:2701HIGHWAY 17
Practice Address - Street 2:STE B
Practice Address - City:RICHMOND
Practice Address - State:GA
Practice Address - Zip Code:31324-3799
Practice Address - Country:US
Practice Address - Phone:912-756-3004
Practice Address - Fax:912-756-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACH6623OtherRAILROAD MEDICARE
GAGRP3618Medicare ID - Type UnspecifiedMEDICARE GROUP #