Healthcare Provider Details

I. General information

NPI: 1366307936
Provider Name (Legal Business Name): COASTAL FAMILY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 HIGHWAY 90
BAY ST LOUIS MS
39520-1524
US

IV. Provider business mailing address

10467 CORPORATE DR
GULFPORT MS
39503-4634
US

V. Phone/Fax

Practice location:
  • Phone: 228-374-2476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANGELIQUE GREER
Title or Position: CEO
Credential:
Phone: 228-374-2494