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Organization

COASTAL FOOT AND ANKLE SPECIALIST, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. NICHOLE DANIELLE MANNING (OFFICE MANAGER)
(912) 265-0709
Entity
Organization

Contact information

Practice address
10 PROFESSIONAL DR, BRUNSWICK, GA 31520-3774
(912) 265-0709
(912) 264-5712
Mailing address
10 PROFESSIONAL DR, BRUNSWICK, GA 31520-3774
(912) 265-0709
(912) 264-5712

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD000997
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
400885615D
GA
Enumeration date
09/21/2015
Last updated
01/17/2017
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