Provider Demographics
NPI:1578088001
Name:COASTAL HEALTH & WELLNESS
Entity Type:Organization
Organization Name:COASTAL HEALTH & WELLNESS
Other - Org Name:COASTAL HEALTH AND WELLNESS, L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMICHAEL-LOBER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:205-919-9279
Mailing Address - Street 1:14 CONFEDERATE DR S
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-3062
Mailing Address - Country:US
Mailing Address - Phone:205-919-9279
Mailing Address - Fax:208-947-3465
Practice Address - Street 1:14 CONFEDERATE DR S
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-3062
Practice Address - Country:US
Practice Address - Phone:205-919-9279
Practice Address - Fax:208-947-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care