Healthcare Provider Details

I. General information

NPI: 1972744258
Provider Name (Legal Business Name): COASTAL EAR NOSE & THROAT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 COMMERCIAL DR
SAVANNAH GA
31406
US

IV. Provider business mailing address

322 COMMERCIAL DR SUITE 2
SAVANNAH GA
31406-3625
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-2335
  • Fax: 770-217-3339
Mailing address:
  • Phone: 912-355-2335
  • Fax: 912-355-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. RHONDA OLIVER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 912-355-2335