# COASTLINE MEDICAL CENTER, PLLC

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

## Provider details

- **NPI number:** 1952525859
- **Authorized official:** DR. NGUYEN PHONG HUYNH D.O (PHYSICIAN)
- **Authorized official phone:** (228) 396-0333

## Contact information

- **Practice address:** 10536 AUTO MALL PKWY, SUITE A, DIBERVILLE, MS 39540-3742
- **Practice address phone:** (228) 396-0333
- **Practice address fax:** (228) 396-4060
- **Mailing address:** 10536 AUTO MALL PKWY, A, DIBERVILLE, MS 39540-3742
- **Mailing address phone:** (228) 396-0333
- **Mailing address fax:** (228) 396-4060

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 19050 | MS | — |
| 207R00000X | Internal Medicine Physician | 19541 | MS | Yes |

## Other

- **Enumeration date:** 04/12/2007
- **Last updated:** 01/04/2011