Provider Demographics
NPI:1992742845
Name:COASTAL ALLERGY & ASTHMA PC
Entity type:Organization
Organization Name:COASTAL ALLERGY & ASTHMA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TESSIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:912-354-6190
Mailing Address - Street 1:505 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2668
Mailing Address - Country:US
Mailing Address - Phone:912-354-6190
Mailing Address - Fax:912-354-6172
Practice Address - Street 1:505 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2668
Practice Address - Country:US
Practice Address - Phone:912-354-6190
Practice Address - Fax:912-354-6172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAC16208OtherRAILROAD MEDICARE GROUP #
GAC16208OtherRAILROAD MEDICARE GROUP #