# SOUTHCOAST MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467451922
- **Authorized official:** MR. JOHN MARRERO (ADMINISTRATOR)
- **Authorized official phone:** (912) 303-3552

## Contact information

- **Practice address:** 330 BENEFIELD DR, SAVANNAH, GA 31406-2604
- **Practice address phone:** (912) 303-3552
- **Practice address fax:** (912) 303-3506
- **Mailing address:** PO BOX 15849, SAVANNAH, GA 31416-2549
- **Mailing address phone:** (912) 303-3552
- **Mailing address fax:** (912) 303-3506

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | GA | Yes |
| 207R00000X | Internal Medicine Physician | — | GA | — |
| 207RC0000X | Cardiovascular Disease Physician | — | GA | — |
| 207RI0200X | Infectious Disease Physician | — | GA | — |
| 207RN0300X | Nephrology Physician | 047425 | GA | — |
| 207RP1001X | Pulmonary Disease Physician | — | GA | — |
| 207V00000X | Obstetrics & Gynecology Physician | 022482 | GA | — |
| 207W00000X | Ophthalmology Physician | — | GA | — |
| 208000000X | Pediatrics Physician | — | GA | — |
| 2084N0400X | Neurology Physician | 064752 | GA | — |
| 2085R0202X | Diagnostic Radiology Physician | — | GA | — |
| 208600000X | Surgery Physician | 021614 | GA | — |
| 225100000X | Physical Therapist | — | GA | — |
| 363A00000X | Physician Assistant | — | GA | — |
| 363L00000X | Nurse Practitioner | — | GA | — |

## Other

- **Enumeration date:** 07/18/2005
- **Last updated:** 07/21/2022