# COASTAL CAROLINA UROLOGY GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124161682
- **Authorized official:** TAMMY SUE HOWE (BILLING SUPERVISOR)
- **Authorized official phone:** (888) 482-4871

## Contact information

- **Practice address:** 1010 MEDICAL CENTER DR, SUITE 100, HARDEEVILLE, SC 29927-3447
- **Practice address phone:** (843) 342-7607
- **Practice address fax:** (843) 342-7640
- **Mailing address:** PO BOX 440007, NASHVILLE, TN 37244-0007
- **Mailing address phone:** (888) 482-4871
- **Mailing address fax:** (615) 261-6052

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 10062233 | SC | Yes |

## Other

- **Enumeration date:** 02/15/2007
- **Last updated:** 08/22/2020