MEDICARE: COASTAL AUDIOLOGY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist

General Provider Information

NPI Number	:	1518138940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL AUDIOLOGY INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 52
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4051
Country	:	US
Telephone Number	:	912-748-9494
Fax Number	:	912-748-9495

Provider Business Practice Location Address
First Line	:	410 US HIGHWAY 80 SW
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-2541
Country	:	US
Telephone Number	:	912-748-9494
Fax Number	:	912-748-9495

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. DAWN HOSTETLER MACMILLAN
Credential	:	AU.D, F-AAA
Telephone Number	:	912-748-9494

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	01/03/2024

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