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Organization
COASTAL CAROLINA OB GYN LLC
Active
Organization
COASTAL CAROLINA OB GYN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA WHITESTONE (INSURANCE BILLING CLERK)
(843) 349-0100
Entity
Organization
Contact information
Practice address
620 SINGLETON RIDGE RD, CONWAY, SC 29526-9154
(843) 349-0100
(843) 349-0104
Mailing address
PO BOX 50754, MYRTLE BEACH, SC 29579
(843) 349-0100
(843) 349-0104
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
115921
SC
207V00000X
Obstetrics & Gynecology Physician
23311
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3863
—
SC
Enumeration date
06/02/2006
Last updated
03/10/2015
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