NPIMap

Organization Active NPI

Coastal Community Health Services, Inc.

Doing business as Heron Health Center- School Based Clinic

  • Federally Qualified Health Center (FQHC)
  • Nahunta, GA
National Provider Identifier
1497554919
Registry record updated Oct 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COASTAL COMMUNITY HEALTH SERVICES, INC.
Doing business as
Heron Health Center- School Based Clinic
Practice address
10804 Highway 82
Nahunta, GA 31553-3704
Phone
(912) 342-7281
NPI assigned
Mar 8, 2025
Last updated
Oct 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2025

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

10804 Highway 82
Nahunta, GA 31553-3704

Mailing address

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

Other names 1

  • Heron Health Center- School Based Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251201000276 GA Part A Provider - Federally Qualified Health Center (FQHC) 0345463683 Practice locations: Nahunta, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497554919. Details of each certification follow.

Federally qualified health center certification: CCN C21052

Legal name
COASTAL COMMUNITY HEALTH SERVICES INC
Doing business as
HERON HEALTH CENTER- SCHOOL BASED CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 4, 2025
Last certification
Nov 4, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
10804 Highway 82
Nahunta, GA 31553-3704

Other NPIs with the same Medicare PAC ID 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Coastal HLTH Srvcs Inc24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Ownership & related parties

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 Jan 9, 2020
Kavanaugh Chandler Individual Corporate DirectorCeo Jul 1, 2021
W-2 Managing Employee Jul 6, 2021
Jeffery Clark Individual Corporate Director Aug 17, 2022
Samantha Young Individual Corporate Director Jun 26, 2023
Josiah Watts Individual Corporate Director Aug 30, 2022
D'Jon McNair Individual Corporate Director Jun 23, 2023

NPI Registry JSON

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

{
    "created_epoch": "1741392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760572800000",
    "number": "1497554919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL CENTER DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315256743",
            "telephone_number": "912-275-8028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10804 HIGHWAY 82",
            "city": "NAHUNTA",
            "state": "GA",
            "postal_code": "315533704",
            "telephone_number": "912-342-7281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL COMMUNITY HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-08",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A",
        "authorized_official_last_name": "CHANDLER",
        "authorized_official_first_name": "KAVANAUGH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-275-8028",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heron Health Center- School Based Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nahunta, GA

Sources for this page

Verify at the official NPI Registry.