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General NPI Number Information
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NPI Number | 1881132264
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Entity Type | Organization
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Legal Business Name | COASTAL PRIMARY CARE, LLC
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 314 RIVER BEND RD
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City | RICHMOND HILL
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State | GA
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Zip | 31324-4306
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Country | US
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Telephone | 912-665-6479
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Fax |
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Provider Business Mailing Address
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Address Line | 314 RIVER BEND RD
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City | RICHMOND HILL
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State | GA
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Zip | 31324-4306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | MARLI MAGNET
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Credential | FNP
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Telephone | 912-665-6479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 17011151
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License Number State | GA
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