Healthcare Provider Details

I. General information

NPI: 1205747458
Provider Name (Legal Business Name): COASTAL ALLERGY PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 EISENHOWER DR
SAVANNAH GA
31406-2668
US

IV. Provider business mailing address

505 EISENHOWER DR
SAVANNAH GA
31406-2668
US

V. Phone/Fax

Practice location:
  • Phone: 912-307-9002
  • Fax:
Mailing address:
  • Phone: 912-307-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY PERRY
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 470-508-5343