Southern Coastal ENT PC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

057327 Issued in GA

Legal business name

SOUTHERN COASTAL ENT PC

Practice address

2500 Starling St
Suite 403
Brunswick, GA 31520-4265

Phone

(912) 265-3210

Fax

(912) 265-1481

NPI assigned

Nov 6, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sherman A Stevenson, MD

Title

Owner

Phone

(912) 265-3210

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216080000000",
    "number": "1104905405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 STARLING ST",
            "address_2": "SUITE 403",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204265",
            "telephone_number": "912-265-3210",
            "fax_number": "912-265-1481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 STARLING ST",
            "address_2": "SUITE 403",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204265",
            "telephone_number": "912-265-3210",
            "fax_number": "912-265-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COASTAL ENT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2008-07-15",
        "status": "A",
        "authorized_official_last_name": "STEVENSON",
        "authorized_official_first_name": "SHERMAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-265-3210",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "057327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078903405A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeastern Pathology Associates PC
• Southeastern Pharmacy LLC
• Southeastern Pharmacy LLC
• Southeastern Surgical Associates
• Sadye Souther, D.M.D.
• Southern Orthopaedics and Sports Medicine
• Southern Orthopaedics and Sports Medicine, P.C.
• Southerncare, Inc.
• Southwest Mobility Incorporated
• Southwest Mobility Incorporated

• Otolaryngology Physician in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Otolaryngology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.