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General NPI Number Information
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NPI Number | 1811028558
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Entity Type | Organization
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Legal Business Name | COASTAL HEAD & NECK ASSOCIATES, PC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1107 GLOUCESTER ST
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City | BRUNSWICK
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State | GA
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Zip | 31520-7053
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Country | US
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Telephone | 912-466-8899
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Fax | 912-466-8887
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | BRUNSWICK
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State | GA
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Zip | 31521-0130
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Country | US
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Telephone | 912-466-8899
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Fax | 912-466-8887
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Authorized Official
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Title or Position | CEO
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Name | DR. KENNETH C FLETCHER JR.
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Credential | M.D.
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Telephone | 912-466-8899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 057614
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License Number State | GA
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