Provider Demographics
NPI:1285149427
Name:URGENT CARE OF COASTAL GEORGIA
Entity type:Organization
Organization Name:URGENT CARE OF COASTAL GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:ARTURO
Authorized Official - Last Name:MALAVER-REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-510-8224
Mailing Address - Street 1:214 PROFESSIONAL CIR STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3783
Mailing Address - Country:US
Mailing Address - Phone:912-510-8224
Mailing Address - Fax:912-576-4791
Practice Address - Street 1:214 A PROFESSIONAL CIRCLE
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065138208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty