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General NPI Number Information
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NPI Number | 1194949248
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Entity Type | Organization
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Legal Business Name | COASTAL MEDICAL SPECIALISTS IN LUNG & CRITICAL CARE, PC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 411 STEPHENSON AVE
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City | SAVANNAH
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State | GA
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Zip | 31405-5968
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Country | US
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Telephone | 912-354-7679
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Fax | 912-354-4018
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Provider Business Mailing Address
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Address Line | 411 STEPHENSON AVE
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City | SAVANNAH
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State | GA
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Zip | 31405-5968
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Country | US
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Telephone | 912-354-7679
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Fax | 912-354-4018
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Authorized Official
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Title or Position | CEO/MD
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Name | DR. ADEWUMI O OGUNTUMIBI
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Credential | M.D.
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Telephone | 912-354-7679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 049393
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License Number State | GA
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