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Organization
COASTAL FOOT AND ANKLE SPECIALIST, LLC
Active
Organization
COASTAL FOOT AND ANKLE SPECIALIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY BENTON DYAL JR. DPM (OWNER)
(912) 266-3649
Entity
Organization
Contact information
Practice address
10 PROFESSIONAL DR, BRUNSWICK, GA 31520-3774
(912) 265-0709
(912) 264-5712
Mailing address
10 PROFESSIONAL DR, BRUNSWICK, GA 31520-3774
(912) 265-0709
(912) 264-5712
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD000997
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400885615D
—
GA
Enumeration date
09/21/2015
Last updated
06/24/2026
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