Provider Demographics
NPI:1700543071
Name:COASTAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:COASTAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:NAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:912-441-5240
Mailing Address - Street 1:204 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-4596
Mailing Address - Country:US
Mailing Address - Phone:912-884-9255
Mailing Address - Fax:912-884-9257
Practice Address - Street 1:204 BUTLER ST
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-4596
Practice Address - Country:US
Practice Address - Phone:912-884-9255
Practice Address - Fax:912-884-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty