Provider Demographics
NPI:1942827332
Name:PRIMARY CARE OF COASTAL GEORGIA
Entity Type:Organization
Organization Name:PRIMARY CARE OF COASTAL GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-510-8224
Mailing Address - Street 1:214A PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558
Mailing Address - Country:US
Mailing Address - Phone:912-510-8224
Mailing Address - Fax:912-576-4791
Practice Address - Street 1:214A PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:ST MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558
Practice Address - Country:US
Practice Address - Phone:912-510-8224
Practice Address - Fax:912-576-4791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:URGENT CARE OF COASTAL GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care