COASTAL CANCER CARE, LLC (NPI# 1205104783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205104783 |
| Entity Type | Organization |
| Organization Name | COASTAL CANCER CARE, LLC |
| Practice Address |
4700 Waters Ave Savannah GA 31404-6220 |
| Mailing Address |
Po Box 116187 Atlanta GA 30368-6187 |
| Practice Telephone | 8033508490 |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2011-12-12 |
| Authorized Official Name | JENNIFER GRAY (OFFICE MANAGER) |
| Authorized Official Telephone | 8032618626 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians |
| Street Address |
4700 WATERS AVE |
| City | SAVANNAH |
| State | GA |
| Zip Code | 31404-6220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023012010 | Peter M Britt | Radiology | 4700 Waters Ave, Savannah, GA 31404-6220 | 2005-06-08 |
| 1255938288 | Mckenna Maria Valencia | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-10-02 |
| 1184239451 | Avery Thomas Helms | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-09-13 |
| 1619580800 | Matthew Shannon | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-26 |
| 1679184840 | Anna Tincher | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-12 |
| 1669083168 | Christie Vernon Klinginsmith | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-10 |
| 1396355004 | Noah Radjenovic | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-06 |
| 1558987115 | Alyssa Nadji | Registered Nurse | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-06-19 |
| 1952926065 | Mary Helen Ondriezek | Registered Nurse | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-06-15 |
| 1326661463 | Danielle Marie Carroll | Pharmacist | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043864580 | Carli A Boatright | Registered Nurse | 4750 Waters Ave Suite 206, Savannah, GA 31404 | 2019-08-01 |
| 1619530573 | Morgan Johnson | Student in an Organized Health Care Education/Training Program | Memorial Health University Medical Center, 4700 Waters Ave, Savannah, GA 31404 | 2019-04-17 |
| 1477050243 | Kevin Timperman | Student in an Organized Health Care Education/Training Program | 4700 Waters Avenus, Surgery Residency Program, Mhumc, Savannah, GA 31404 | 2018-04-09 |
| 1376048959 | Nina Jo Paletta | Student in an Organized Health Care Education/Training Program | Memorial University Medical Center, 4700 Waters Ave., Savannah, GA 31404 | 2018-03-27 |
| 1972036200 | Jose Adrian Lara Gonzalez | Student in an Organized Health Care Education/Training Program | 4700 Waters Ave, Memorial University Medical Center, Internal Medicine Residency Program, Savannah, GA 31404 | 2017-04-04 |
| 1407210396 | Lexie Hester Vaughn | Student in an Organized Health Care Education/Training Program | 1250 East 66th St, Savannah, GA 31404 | 2016-04-07 |
| 1336503291 | Miles Love | Student in an Organized Health Care Education/Training Program | 1250 East 66th Street, Savannah, GA 31404 | 2016-04-07 |
| 1134536881 | David Patch | Specialist/Technologist | Pediatric Residency Program, Memorial University, Medical Center 4700 Waters Avenue, Savannah, GA 31404 | 2014-07-15 |
| 1962846683 | Alan Danilo Zevallos | Internal Medicine | 4700 Waters Avenue, University Medical Center, Internal Medicine Residency Program, Memorial Health, Savannah, GA 31404 | 2013-04-24 |
| 1730446394 | Joshua Ryan Fann | Prosthetist | 3840 Waters Ave, Savannah, GA 31404 | 2012-04-19 |
| Find all providers in zip 31404 | ||||
| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003903352 | John Joseph Ptacek | Radiology | 61 Hemingway Circle, Savannah, GA 31411 | 2006-10-06 |
| 1083971683 | Matthew H Bertke | Radiology | 4700 Waters Ave, Savannah, GA 31404-6220 | 2012-04-19 |
| 1134485766 | John Cramer Schuler | Radiology | 225 Candler Dr Ste 100, Savannah, GA 31405-6093 | 2012-04-09 |
| 1023335726 | John Lecraw Mikell | Radiology | 225 Candler Dr Ste 100, Savannah, GA 31405-6093 | 2010-04-21 |
| 1528229788 | Joshua Terry Mckenzie | Radiology | 225 Candler Dr, Suite 100, Savannah, GA 31405-6023 | 2008-06-20 |
| 1770741928 | Michael D Hasselle | Radiology | 4700 Waters Ave, Savannah, GA 31404-6220 | 2008-05-23 |
| 1326211459 | Aaron Watson Pederson | Radiology | 4700 Waters Ave, Savannah, GA 31404 | 2008-04-09 |
| 1790961100 | Savannah Radiation Cancer Care, PC | Radiology | 4700 Waters Ave, Savannah, GA 31404-6220 | 2008-01-16 |
| 1831237148 | John A Pablo | Radiology | 225 Candler Rd, Suite 100, Savannah, GA 31405-6023 | 2007-02-01 |
| 1588702872 | Morris Roy Geffen | Radiology | 225 Candler Rd, Suite 100, Savannah, GA 31405-6023 | 2007-02-01 |
| Find all providers in SAVANNAH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.