# SOUTHCOAST MEDICAL GROUP, LLC

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

## Provider details

- **NPI number:** 1881947802
- **Authorized official:** JOHN MARRERO (ADMINISTRATOR)
- **Authorized official phone:** (912) 303-3552

## Contact information

- **Practice address:** 3780 US HIGHWAY 17, RICHMOND HILL, GA 31324-3378
- **Practice address phone:** (912) 756-2292
- **Practice address fax:** (912) 756-2289
- **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 | 042084 | GA | Yes |
| 207R00000X | Internal Medicine Physician | 039759 | GA | — |

## Other

- **Enumeration date:** 10/16/2012
- **Last updated:** 10/16/2012