Healthcare Provider Details

I. General information

NPI: 1710869250
Provider Name (Legal Business Name): COASTAL CARE MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SKIDAWAY VILLAGE WALK STE B
SAVANNAH GA
31411-2962
US

IV. Provider business mailing address

4 SKIDAWAY VILLAGE WALK STE B
SAVANNAH GA
31411-2962
US

V. Phone/Fax

Practice location:
  • Phone: 912-598-6312
  • Fax:
Mailing address:
  • Phone: 912-598-6312
  • Fax: 912-480-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MERLAN POWELL
Title or Position: EXECUTIVE DIRECTOR
Credential: CPA
Phone: 912-598-6312