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General NPI Number Information
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NPI Number | 1184440463
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Entity Type | Organization
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Legal Business Name | COASTAL COMMUNITY HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 1605 KINGSLEY AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-4435
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Country | US
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Telephone | 904-750-3380
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Fax |
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Provider Business Mailing Address
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Address Line | 100 PROFESSIONAL CENTER DR
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City | BRUNSWICK
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State | GA
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Zip | 31525-6743
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Country | US
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Telephone | 912-574-5075
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KAVANAUGH CHANDLER
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Credential | MD
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Telephone | 912-275-8028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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