| Coastal Community Behavioral Health, Llc | |
|
5155 Ga Highway 40 E Saint Marys GA 31558-9410 | |
| (912) 434-1794 | |
| (912) 662-8785 |
| Full Name | Coastal Community Behavioral Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5155 Ga Highway 40 E, Saint Marys, Georgia |
| Authorized Official Name and Position | John Haigler (ADMINISTRATION) |
| Authorized Official Contact | 9124341794 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Community Behavioral Health, Llc 5155 Ga Highway 40 E Saint Marys GA 31558-9410 Ph: (912) 434-1794 | Coastal Community Behavioral Health, Llc 5155 Ga Highway 40 E Saint Marys GA 31558-9410 Ph: (912) 434-1794 |
| NPI Number | 1457805467 |
|---|---|
| Provider Enumeration Date | 08/08/2016 |
| Last Update Date | 01/05/2023 |
| Certification Date | 01/05/2023 |
| Medicare PECOS PAC ID | 2961785514 |
|---|---|
| Medicare Enrollment ID | O20170206002867 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457805467 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 74308 (Georgia) | Primary |
| 261QM2800X | Clinic/center - Methadone | (* (Not Available)) | Secondary |
| Provider Name | Scott Thomas Miles |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1073512125 PECOS PAC ID: 9032164512 Enrollment ID: I20170206002875 |
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