Provider Demographics
NPI:1700405040
Name:COASTAL PAIN RELIEF CONSULTANTS, LLC
Entity Type:Organization
Organization Name:COASTAL PAIN RELIEF CONSULTANTS, LLC
Other - Org Name:LIFESTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
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:912-665-2458
Mailing Address - Street 1:1207 BELLE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6028
Mailing Address - Country:US
Mailing Address - Phone:912-665-2458
Mailing Address - Fax:
Practice Address - Street 1:315 COMMERCIAL DR STE C5
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3633
Practice Address - Country:US
Practice Address - Phone:912-355-3170
Practice Address - Fax:912-355-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty