Provider Demographics
NPI:1699412734
Name:GULF COAST CONSULTANTS, INFECTIOUS DISEASES, LLC
Entity Type:Organization
Organization Name:GULF COAST CONSULTANTS, INFECTIOUS DISEASES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-236-4262
Mailing Address - Street 1:2572 BRIGHTON CIR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2733
Mailing Address - Country:US
Mailing Address - Phone:228-236-4262
Mailing Address - Fax:
Practice Address - Street 1:2572 BRIGHTON CIR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2733
Practice Address - Country:US
Practice Address - Phone:228-236-4262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty