Provider Demographics
NPI:1760701056
Name:NEUROLOGY CLINIC OF COASTAL GEORGIA, LLC
Entity Type:Organization
Organization Name:NEUROLOGY CLINIC OF COASTAL GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BRICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-634-4849
Mailing Address - Street 1:7000 WELLNESS WAY
Mailing Address - Street 2:SUITE 7210
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2286
Mailing Address - Country:US
Mailing Address - Phone:912-634-4849
Mailing Address - Fax:912-634-4850
Practice Address - Street 1:7000 WELLNESS WAY
Practice Address - Street 2:SUITE 7210
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2286
Practice Address - Country:US
Practice Address - Phone:912-634-4849
Practice Address - Fax:912-634-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0450422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty