NPIMap

Organization Active NPI

Coastal Head & Neck Associates, PC

  • Otolaryngology Physician
  • Brunswick, GA
National Provider Identifier
1811028558
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
057614 Issued in GA
Legal business name
COASTAL HEAD & NECK ASSOCIATES, PC
Practice address
1107 Gloucester St
Brunswick, GA 31520-7053
Phone
(912) 466-8899
Fax
(912) 466-8887
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kenneth C Fletcher Jr., M.D.NPI 1477575876
Title
Ceo
Phone
(912) 466-8899

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
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X 057614 GA Primary

Addresses

Primary practice location

1107 Gloucester St
Brunswick, GA 31520-7053

Mailing address

PO Box 130
Brunswick, GA 31521-0130
Phone (912) 466-8899

Other names 1

  • KENNETH C FLETCHER JR Doing business as

National Provider Directory

National Provider Directory

Locations

1107 Gloucester St
Brunswick, GA 31520
Phone (912) 466-8899

Practitioners & affiliated clinicians

Practitioners 3

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": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811028558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315210130",
            "telephone_number": "912-466-8899",
            "fax_number": "912-466-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 GLOUCESTER ST",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315207053",
            "telephone_number": "912-466-8899",
            "fax_number": "912-466-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL HEAD & NECK ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-466-8899",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "057614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KENNETH C FLETCHER JR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brunswick, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.