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Coastal Community Health Services, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Brunswick, GA

NPI 1063282937 · NPPES record last updated Jan 3, 2024

Key facts

NPI
1063282937
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
COASTAL COMMUNITY HEALTH SERVICES, INC.
Practice address
2747 4TH St
Brunswick, GA 31520-3714
Phone
(912) 289-2617
NPI assigned
Jan 3, 2024
Organization subpart
No

Authorized official

Name
Kavanaugh Chandler, MD
Title
Ceo
Phone
(912) 275-8028

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 23

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 118

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 118

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2340192Coastal Community Health- County Clinic
2747 Fourth Street, Brunswick, GA 31520		Provider-performed microscopyMar 12, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Federally qualified health center certification: CCN C21038

Legal name
COASTAL COMMUNITY HEALTH SERVICES INC
Doing business as
CCH-GLYNN COUNTY EMPLOYEE HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 13, 2025
Last certification
May 13, 2025
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Oct 25, 2012 in GA
Enrollment address
2747 4TH St
Brunswick, GA 31520-3714

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Faye Mathis
Individual 		Corporate Director
Board Vice Chair		 Jan 9, 2020
Kavanaugh Chandler
Individual 		Corporate Director
Ceo		 Jul 1, 2021 100%
W-2 Managing Employee
Ceo		 Jul 6, 2021 100%
Jeffery Clark
Individual 		Corporate Director
Board Treasurer		 Jun 17, 2022
Samantha Young
Individual 		Corporate Director
Board Member		 Jun 26, 2023
Josiah Watts
Individual 		Corporate Director
Board Chair		 Aug 30, 2022
D'Jon McNair
Individual 		Corporate Director
Board Member		 Jun 26, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20250528003801 GA Part a Provider - Federally Qualified Health Center (FQHC) 0345463683 Practice locations: Brunswick, GA

National Provider Directory

Tax ID family
Coastal HLTH Srvcs Inc (24 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

2747 4TH St
Brunswick, GA 31520-3714

Mailing address

100 Professional Center Dr
Brunswick, GA 31525-6743
Phone (912) 275-8028

Other names

  • Coastal Community Health County Clinic Doing business as

Other providers in Brunswick, GA

All providers in Brunswick, GA · Federally Qualified Health Center (FQHC) in Georgia

Sources for this page

Verify at the official NPI Registry.