Healthcare Provider Details

I. General information

NPI: 1821924424
Provider Name (Legal Business Name): COASTLIFT MEDICAL TRANSPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 KINGS BAY ROAD STE A, PMB 102
SAINT MARYS GA
31558
US

IV. Provider business mailing address

944 KINGS BAY ROAD STE A, PMB 102
SAINT MARYS GA
31558
US

V. Phone/Fax

Practice location:
  • Phone: 912-464-3780
  • Fax:
Mailing address:
  • Phone: 912-464-3780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: SHEENA GARDNER
Title or Position: PRESIDENT
Credential:
Phone: 912-464-3780