Organization
COASTAL EMPIRE IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN C BRIDGES (PROVIDER RELATIONS)
(912) 354-4164
Entity
Organization
Contact information
Practice address
1000 MEDICAL CENTER DR, HARDEEVILLE, SC 29927-3446
(912) 354-4164
(912) 303-4940
Mailing address
PO BOX 15479, SAVANNAH, GA 31416-2179
(912) 354-4164
(912) 303-4940
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10069441
AMERIGROUP
GA
01
—
DE7906
RAILROAD MEDICARE
GA
01
—
DF1119
RAILROAD MEDICARE
SC
05
—
GP4519
—
SC
Enumeration date
05/18/2006
Last updated
01/07/2009
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