=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003725474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTVIEW PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2026
-----------------------------------------------------
Last Update Date | 09/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101B VILLA DRIVE STE 226
-----------------------------------------------------
City | DAPHNE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-615-0000
-----------------------------------------------------
Fax | 866-433-9000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101B VILLA DRIVE STE 226
-----------------------------------------------------
City | DAPHNE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-615-0000
-----------------------------------------------------
Fax | 866-433-9000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDING PHYSICIAN
-----------------------------------------------------
Name | DR. MARCUS HAMILTON LACKEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 850-281-8656
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084A0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084P0802X
-----------------------------------------------------
Taxonomy Name | Addiction Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------