Provider Demographics
NPI:1952644973
Name:COASTAL GEORGIA OBSTETRICS AND GYNECOLOGY
Entity Type:Organization
Organization Name:COASTAL GEORGIA OBSTETRICS AND GYNECOLOGY
Other - Org Name:THRIVE OBSTETRICS AND GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-721-9595
Mailing Address - Street 1:5356 REYNOLDS STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-721-9595
Mailing Address - Fax:912-298-0899
Practice Address - Street 1:5356 REYNOLDS STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-721-9595
Practice Address - Fax:912-298-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67917207V00000X
GA67946207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty