SOUTHCOAST MEDICAL GROUP LLC NPI 1467451922

NPI Information

NPI: 1467451922
Provider Name: SOUTHCOAST MEDICAL GROUP, LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 11D0264872

Address:
330 BENEFIELD DR
SAVANNAH, GA
ZIP 31406
Phone: (912) 303-3552
Get Directions

SOUTHCOAST MEDICAL GROUP, LLC is a family medicine in Savannah, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SOUTHCOAST MEDICAL GROUP, LLC NPI is 1467451922. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

330 BENEFIELD DR
SAVANNAH, GA
ZIP 31406-604
Phone: (912) 303-3552
Fax: (912) 303-3506

The provider's authorized official is John Marrero .
The authorized official title is Administrator and has the following contact phone number (912) 303-3552.

The CLIA number assigned to this NPI record is 11D0264872 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 7/18/2005 and was last updated on 7/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084N0400X	Psychiatry & Neurology	Neurology	064752	GEORGIA	No
2	207RN0300X	Internal Medicine	Nephrology	047425	GEORGIA	No
3	207V00000X	Obstetrics & Gynecology		022482	GEORGIA	No
4	208600000X	Surgery		021614	GEORGIA	No
5	207R00000X	Internal Medicine			GEORGIA	No
6	207RC0000X	Internal Medicine	Cardiovascular Disease		GEORGIA	No
7	207RI0200X	Internal Medicine	Infectious Disease		GEORGIA	No
8	207RP1001X	Internal Medicine	Pulmonary Disease		GEORGIA	No
9	207W00000X	Ophthalmology			GEORGIA	No
10	208000000X	Pediatrics			GEORGIA	No
11	2085R0202X	Radiology	Diagnostic Radiology		GEORGIA	No
12	225100000X	Physical Therapist			GEORGIA	No
13	363A00000X	Physician Assistant			GEORGIA	No
14	363L00000X	Nurse Practitioner			GEORGIA	No
15	207Q00000X	Family Medicine			GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	909802000	MEDICAID	FLORIDA
2	GPA3131	MEDICAID	SOUTH CAROLINA
3	GPA643	MEDICAID	SOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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