Healthcare Provider Details

I. General information

NPI: 1003725474
Provider Name (Legal Business Name): COASTVIEW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101B VILLA DRIVE STE 226
DAPHNE AL
36526
US

IV. Provider business mailing address

101B VILLA DRIVE STE 226
DAPHNE AL
36526
US

V. Phone/Fax

Practice location:
  • Phone: 251-615-0000
  • Fax: 866-433-9000
Mailing address:
  • Phone: 251-615-0000
  • Fax: 866-433-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARCUS HAMILTON LACKEY
Title or Position: FOUNDING PHYSICIAN
Credential: MD
Phone: 850-281-8656