Healthcare Provider Details

I. General information

NPI: 1912862301
Provider Name (Legal Business Name): GOLDEN ISLES COASTAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5873 US HIGHWAY 17 STE A
DARIEN GA
31305-4015
US

IV. Provider business mailing address

PO BOX 654
DARIEN GA
31305-0654
US

V. Phone/Fax

Practice location:
  • Phone: 912-266-6605
  • Fax:
Mailing address:
  • Phone: 912-266-6605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CYNDI B FAUDREE
Title or Position: CEO
Credential:
Phone: 912-266-6605