Southcoast Medical Group, LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

047425 Issued in GA

Legal business name

SOUTHCOAST MEDICAL GROUP, LLC

Practice address

1326 Eisenhower Dr
Savannah, GA 31406-3928

Phone

(912) 691-4100

Fax

(912) 691-4209

NPI assigned

Oct 24, 2012

Last updated

Oct 24, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Marrero

Title

Administrator

Phone

(912) 303-3552

Specialties & licenses 8

Addresses

Tax ID family

Southcoast Medical Group LLC2 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.

• Southcoast Medical Group P C

  dba SouthCoast Pharmacy

  • Clinic Pharmacy
  • Savannah, GA
  • NPI 1740584770
  NPD tax ID

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

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351036800000",
    "number": "1861745119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15849",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314162549",
            "telephone_number": "912-303-3552",
            "fax_number": "912-303-3506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1326 EISENHOWER DR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063928",
            "telephone_number": "912-691-4100",
            "fax_number": "912-691-4209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCOAST MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-24",
        "last_updated": "2012-10-24",
        "status": "A",
        "authorized_official_last_name": "MARRERO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "912-303-3552"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "5306",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN077768",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "020999",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "038715",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "047425",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "GA",
            "license": "026247",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "064752",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "039937",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Georgia Hospitalist Services, LLC
• South Georgia Radiology Associates, LLC
• Jacob A South, GENETIC COUNSELOR
• Southcoast Medical Group P C (SouthCoast Pharmacy)
• Southcoast Medical Group, LLC
• Southeast Georgia Neurological Centers, PC (Chatham Neurology)
• Southeast Lung & Critical Care Specialists
• Southeast Lung & Critical Care Specialists
• Southeast Lung & Critical Care Specialists
• Southeast Lung & Critical Care Specialists

• Nephrology Physician in Savannah, GA
• Providers in Savannah, GA by specialty
• Nephrology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2012; 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.