# COASTAL CAROLINA INFECTIOUS DISEASE, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1265898191
- **Authorized official:** MARLENE THORNHILL (BILLING MANAGER)
- **Authorized official phone:** (843) 668-2376

## Contact information

- **Practice address:** 1110 LONDON ST STE 102, MYRTLE BEACH, SC 29577
- **Practice address phone:** (843) 668-2376
- **Practice address fax:** (843) 748-0613
- **Mailing address:** 1110 LONDON ST STE 102, MYRTLE BEACH, SC 29577-5799
- **Mailing address phone:** (843) 668-2376
- **Mailing address fax:** (843) 748-0613

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0200X | Infectious Disease Physician | — | SC | Yes |

## Other

- **Enumeration date:** 01/07/2016
- **Last updated:** 05/17/2018