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General NPI Number Information
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NPI Number | 1992299291
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Entity Type | Organization
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Legal Business Name | COASTAL HEALTHCARE SERVICES P C
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 116 FAIRHOPE AVE STE 1
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City | FAIRHOPE
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State | AL
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Zip | 36532
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Country | US
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Telephone | 251-255-5335
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Fax |
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Provider Business Mailing Address
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Address Line | 116 FAIRHOPE AVE STE 1
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City | FAIRHOPE
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State | AL
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Zip | 36532-2314
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Country | US
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Telephone | 251-255-5335
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN SAWRIE
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Credential | MD, PHD
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Telephone | 251-255-5335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 26183
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License Number State | AL
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