Healthcare Provider Details

I. General information

NPI: 1609795566
Provider Name (Legal Business Name): COASTAL AESTHETIC & RECONSTRUCTIVE SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 STEPHENSON AVE STE 101
SAVANNAH GA
31405-5985
US

IV. Provider business mailing address

613 STEPHENSON AVE STE 101
SAVANNAH GA
31405-5985
US

V. Phone/Fax

Practice location:
  • Phone: 912-228-4605
  • Fax: 912-335-3461
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANAND RAJ KUMAR
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 240-481-2701