MEDICARE: COASTAL HEALTH SERVICES, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1952390080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	440 INDUSTRIAL BLVD
Second Line	:	P.O. BOX 1033
City	:	HAWKINSVILLE
State	:	GA
Zip	:	31036-2106
Country	:	US
Telephone Number	:	478-783-4988
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 DOROTHY ST
Second Line	:
City	:	WAYCROSS
State	:	GA
Zip	:	31501-7161
Country	:	US
Telephone Number	:	478-783-4988
Fax Number	:

Authorized Official
Title or Position	:	MEDICARE PART B COORDINATOR
Name	:	DEBORAH COLEY
Credential	:
Telephone Number	:	478-783-4988

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	08/22/2020

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