Organization
COASTAL PLAIN RADIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA STEPHENSON D.O. (DIRECT OWNER)
(205) 531-2857
Entity
Organization
Contact information
Practice address
2501 N PATTERSON ST, VALDOSTA, GA 31602-1735
(229) 433-1000
Mailing address
1125 TROUPE ST, AUGUSTA, GA 30904-4480
(706) 667-7450
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003164753B
—
GA
Enumeration date
09/24/2019
Last updated
02/24/2020
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