Provider Demographics
NPI:1952579666
Name:COASTAL MEDICAL SPECIALISTS
Entity Type:Organization
Organization Name:COASTAL MEDICAL SPECIALISTS
Other - Org Name:COASTAL MEDICAL SPECIALISTS IN LUNG & CRITICAL CARE, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LASHAWN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-7679
Mailing Address - Street 1:3710 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6209
Mailing Address - Country:US
Mailing Address - Phone:912-354-7679
Mailing Address - Fax:
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4353
Practice Address - Country:US
Practice Address - Phone:912-369-5864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049393174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC049393Medicaid
GA00900798EMedicaid
GA00900798DMedicaid
GA00900798CMedicaid
GA00900798FMedicaid
GA00900798GMedicaid
GA00900798FMedicaid
GA00900798GMedicaid