| Coastal Wellness Family Medicine | |
|
102 Lakeshore Dr Ste B Saint Marys GA 31558-3875 | |
| (912) 576-7546 | |
| (912) 576-2348 |
| Full Name | Coastal Wellness Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 102 Lakeshore Dr Ste B, Saint Marys, Georgia |
| Authorized Official Name and Position | Tavia Hall (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9125767546 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Wellness Family Medicine 102 Lakeshore Dr Ste B Saint Marys GA 31558-3875 Ph: (912) 576-7546 | Coastal Wellness Family Medicine 102 Lakeshore Dr Ste B Saint Marys GA 31558-3875 Ph: (912) 576-7546 |
| NPI Number | 1235632449 |
|---|---|
| Provider Enumeration Date | 03/14/2018 |
| Last Update Date | 06/14/2024 |
| Medicare PECOS PAC ID | 4082966411 |
|---|---|
| Medicare Enrollment ID | O20181011001999 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235632449 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Susan L Fricke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124061700 PECOS PAC ID: 9234123993 Enrollment ID: I20181015000320 |
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