Provider Demographics
NPI:1922364629
Name:COASTAL SLEEP SOLLUTIONS LLC
Entity Type:Organization
Organization Name:COASTAL SLEEP SOLLUTIONS LLC
Other - Org Name:COASTAL SLEEP SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINACAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-544-0484
Mailing Address - Street 1:413 W DUFFY ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-6716
Mailing Address - Country:US
Mailing Address - Phone:912-544-0484
Mailing Address - Fax:912-234-2844
Practice Address - Street 1:413 W DUFFY ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-6716
Practice Address - Country:US
Practice Address - Phone:912-544-0484
Practice Address - Fax:912-234-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC-A8412122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty