Organization
COASTAL CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WARREN S THEIS MD (OWNER)
(912) 285-8822
Entity
Organization
Contact information
Practice address
1405 ALICE ST, WAYCROSS, GA 31501-4528
(912) 285-8822
(912) 490-4870
Mailing address
1405 ALICE ST, WAYCROSS, GA 31501-4528
(912) 285-8822
(912) 490-4870
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
055345
GA
261QP2300X
Primary Care Clinic/Center
Primary
055345
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
672694005A
—
GA
Enumeration date
07/05/2007
Last updated
07/01/2024
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