NPIMap

Organization Active NPI

Coastal Pediatrics, LLC

  • Pediatrics Physician
  • Pooler, GA
National Provider Identifier
1659418077
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
051088 Issued in GA
Legal business name
COASTAL PEDIATRICS, LLC
Practice address
1000 Towne Center Blvd Ste 1000B
Pooler, GA 31322
Phone
(912) 353-7744
Fax
(912) 348-3589
NPI assigned
Feb 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Authorized official

Name
Mr. Dudley W. Stone, M.D.NPI 1447316880
Title
Owner
Phone
(912) 353-7744

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 051088 GA Primary

Addresses

Primary practice location

1000 Towne Center Blvd Ste 1000B
Pooler, GA 31322

Mailing address

1000 Towne Center Blvd Ste 1000B
Pooler, GA 31322-4129
Phone (912) 353-7744

Other names 1

  • Coastal Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Coastal Pediatrics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1000 Towne Center Blvd
Ste 1000B
Pooler, GA 31322
Phone (912) 353-7744

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1659418077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 TOWNE CENTER BLVD STE 1000B",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224129",
            "telephone_number": "912-353-7744",
            "fax_number": "912-348-3589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 TOWNE CENTER BLVD STE 1000B",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "31322",
            "telephone_number": "912-353-7744",
            "fax_number": "912-348-3589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "DUDLEY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-353-7744",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "051088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pooler, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; 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.