Provider Demographics
NPI:1881132264
Name:COASTAL PRIMARY CARE, LLC
Entity type:Organization
Organization Name:COASTAL PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MARLI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNET
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:912-665-6479
Mailing Address - Street 1:314 RIVER BEND RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:314 RIVER BEND RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-4306
Practice Address - Country:US
Practice Address - Phone:912-665-6479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17011151261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care