Provider Demographics
NPI:1871871012
Name:COASTAL SLEEP SOLLUTIONS L.L.C.
Entity type:Organization
Organization Name:COASTAL SLEEP SOLLUTIONS L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINACAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-544-0484
Mailing Address - Street 1:413 W DUFFY ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-6716
Mailing Address - Country:US
Mailing Address - Phone:912-544-0484
Mailing Address - Fax:912-238-4484
Practice Address - Street 1:413 W DUFFY ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-6716
Practice Address - Country:US
Practice Address - Phone:912-544-0484
Practice Address - Fax:912-238-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA8412261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic