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General NPI Number Information
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NPI Number | 1134467533
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Entity Type | Organization
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Legal Business Name | HOUSE CALLS OF COASTAL GEORGIA, PC
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Dates
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Enumeration Date | 01/21/2013
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 811 SAND DOLLAR TRCE
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City | ST SIMONS ISLAND
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State | GA
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Zip | 31522-3761
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Country | US
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Telephone | 912-580-6913
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Fax | 912-265-2859
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Provider Business Mailing Address
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Address Line | 811 SAND DOLLAR TRCE
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City | ST SIMONS ISLAND
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State | GA
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Zip | 31522-3761
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Country | US
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Telephone | 912-580-6913
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Fax | 912-265-1212
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Authorized Official
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Title or Position | MANAGER
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Name | ISMAEL SALIM OSTA
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Credential | PA-C
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Telephone | 912-581-6913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15631
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License Number State |
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