Provider Demographics
NPI:1659881290
Name:COASTAL FERTILITY CENTER
Entity Type:Organization
Organization Name:COASTAL FERTILITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:ORMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-606-3943
Mailing Address - Street 1:1375 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3254
Mailing Address - Country:US
Mailing Address - Phone:843-883-5800
Mailing Address - Fax:
Practice Address - Street 1:9100 WHITE BLUFF RD STE 201
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4600
Practice Address - Country:US
Practice Address - Phone:912-421-1285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty