Organization
COASTAL COMMUNITY HEALTH SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAVANAUGH CHANDLER (CEO)
(912) 275-8028
Entity
Organization
Contact information
Practice address
1600 ELLIS ST, BRUNSWICK, GA 31520-6737
(912) 574-5279
(912) 785-2147
Mailing address
106 SHOPPERS WAY STE 114, BRUNSWICK, GA 31525-0522
(912) 275-8028
(912) 275-8610
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Enumeration date
09/16/2022
Last updated
09/16/2022
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