MEDICARE: COASTAL ANESTHESIA & PAIN RELIEF SPECIALISTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH6623	OTHER	GA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1063460004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL ANESTHESIA & PAIN RELIEF SPECIALISTS

Provider Business Mailing Address
First Line	:	PO BOX 235022
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36123-5022
Country	:	US
Telephone Number	:	334-386-2053
Fax Number	:	334-244-1830

Provider Business Practice Location Address
First Line	:	2701HIGHWAY 17
Second Line	:	STE B
City	:	RICHMOND
State	:	GA
Zip	:	31324-3799
Country	:	US
Telephone Number	:	912-756-3004
Fax Number	:	912-756-5921

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AMY PEARSON
Credential	:	M.D.
Telephone Number	:	912-756-3004

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	11/30/2009

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