Provider Demographics
NPI:1922327055
Name:COASTAL PEDIATRICS, LLC
Entity Type:Organization
Organization Name:COASTAL PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-353-7744
Mailing Address - Street 1:2 WHEELER ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5700
Mailing Address - Country:US
Mailing Address - Phone:912-353-7744
Mailing Address - Fax:912-355-9124
Practice Address - Street 1:2 WHEELER ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5700
Practice Address - Country:US
Practice Address - Phone:912-353-7744
Practice Address - Fax:912-355-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51088208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty