Provider Demographics
NPI:1396149076
Name:COASTAL MEDICAL ARTS, LLC
Entity type:Organization
Organization Name:COASTAL MEDICAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-232-9700
Mailing Address - Street 1:257 CATHERINE VW
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-5175
Mailing Address - Country:US
Mailing Address - Phone:912-232-9700
Mailing Address - Fax:912-232-9701
Practice Address - Street 1:103 E GENERAL STEWART WAY
Practice Address - Street 2:SUITE B
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2607
Practice Address - Country:US
Practice Address - Phone:912-332-5621
Practice Address - Fax:912-232-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA53170207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty