Organization
SOUTHCOAST MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MARRERO (ADMINISTRATOR)
(912) 303-3552
Entity
Organization
Contact information
Practice address
3780 US HIGHWAY 17, RICHMOND HILL, GA 31324-3378
(912) 756-2292
(912) 756-2289
Mailing address
PO BOX 15849, SAVANNAH, GA 31416-2549
(912) 303-3552
(912) 303-3506
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042084
GA
207R00000X
Internal Medicine Physician
039759
GA
Other
Enumeration date
10/16/2012
Last updated
10/16/2012
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