COASTAL CARE INC NPI 1538367149

NPI Information

  • NPI: 1538367149
  • Provider Name: COASTAL CARE INC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Address: 1405 ALICE ST
    WAYCROSS, GA
    ZIP 31501
  • Phone: (912) 285-8822

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NPI Details

COASTAL CARE INC is a primary care clinic center in Waycross, GA. COASTAL CARE INC NPI is 1538367149. The provider is registered as an organization entity type.

The provider's business location address is:

1405 ALICE ST
WAYCROSS, GA
ZIP 31501-528
Phone: (912) 285-8822
Fax: (912) 490-4870

The provider's authorized official is Warren S Theis .
The authorized official title is Owner and has the following contact phone number (912) 285-8822.

The enumeration date for this NPI number is 7/5/2007 and was last updated on 7/1/2024.

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
1261Q00000XClinic/Center055345GEORGIANo
2261QP2300XClinic/CenterPrimary Care055345GEORGIAYes

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 Other Provider Identifier Issuer
1672694005AMEDICAIDGEORGIA

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: 11/21/2025

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