Healthcare Provider Details

I. General information

NPI: 1922364629
Provider Name (Legal Business Name): COASTAL SLEEP SOLLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W DUFFY ST
SAVANNAH GA
31401-6716
US

IV. Provider business mailing address

413 W DUFFY ST
SAVANNAH GA
31401-6716
US

V. Phone/Fax

Practice location:
  • Phone: 912-544-0484
  • Fax: 912-234-2844
Mailing address:
  • Phone: 912-544-0484
  • Fax: 912-234-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberC-A8412
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP W. COOPER JR.
Title or Position: CLINACAL DIRECTOR
Credential: D.D.S.
Phone: 912-544-0484