Coastal Allergy & Asthma PC
Organization Active NPI Allergy & Immunology Physician · Savannah, GA
NPI 1992742845 · NPPES record last updated Nov 4, 2022
Key facts
- NPI
- 1992742845
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Allergy & Immunology Physician 207K00000X
- Legal business name
- COASTAL ALLERGY & ASTHMA PC
- Practice address
- 505 Eisenhower Dr
Savannah, GA 31406-2668 - Phone
- (912) 354-6190
- Fax
- (912) 354-6172
- NPI assigned
- Jun 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Tessie J Adams, CMPE
- Title
- Practice Administrator
- Phone
- (912) 354-6190
Practitioners 7
-
Bruce D Finkel, MD
-
Wendy Futch, NP
-
Brad Henry Goodman, M. D.
-
Monica Rama Kenney, M. D.
-
Lisanne P Newton, M.D.
-
Kennadi Meurer, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D0958967 | Coastal Allergy & Asthma PC | Certificate of waiver | Mar 30, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040429000886 | GA | Part B Supplier - Clinic/Group Practice | 3971590050 |
Receives reassigned benefits from 6 practitioners Practice locations: Brunswick, GA; Savannah, GA; Statesboro, GA |
National Provider Directory
Locations
2500 Starling St
Ste 101
Brunswick, GA 31520
Phone (912) 354-6190
2500 Starling St
#200
Brunswick, GA 31520
Phone (912) 354-6190
1219 Merchant Way
Ste 102
Statesboro, GA 30458
Phone (912) 354-6190
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician |
207K00000X | Yes |
Addresses
Primary practice location
505 Eisenhower Dr
Savannah, GA 31406-2668
Mailing address
505 Eisenhower Dr
Savannah, GA 31406-2668
Phone (912) 354-6190
Other practice location 1
2500 Starling St Ste 101
Brunswick, GA 31520-4266
Phone (912) 354-6190
Other practice location 2
119 Hill Pond Ln
Statesboro, GA 30458-0872
Phone (912) 354-6190
Other practice location 3
1219 Merchant Way Ste 102
Statesboro, GA 30458-0885
Phone (912) 354-6190
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C16208 | Other | GA | RAILROAD MEDICARE GROUP # |
Other providers in Savannah, GA
- Charles Frederick Clinton
- Brian Close
- Christadora Clymer
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- Coastal Aesthetic & Reconstructive Surgery, LLC
- Coastal Ambulatory Anesthesia LLC
- Coastal Atlantic Day Habilitation & Treatment Center
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All providers in Savannah, GA · Allergy & Immunology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.