# COASTAL CAROLINA ENT, DO, PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COASTAL CAROLINA ENT, DO, PA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1386989028
- **Legal business name:** COASTAL CAROLINA ENT, DO, PA
- **Authorized official:** MS. WENDY C. PARIS CPC (INSURANCE/BILLING SPECIALIST)
- **Authorized official phone:** (910) 914-0540

## Contact information

- **Practice address:** 3806 SAWTELL RD, LITTLE RIVER, SC 29566-7873
- **Practice address phone:** (843) 663-9090
- **Practice address fax:** (843) 663-9091
- **Mailing address:** 302 LIBERTY ST, WHITEVILLE, NC 28472-3714
- **Mailing address phone:** (910) 914-0540
- **Mailing address fax:** (910) 914-0640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | DO 1480 | SC | Yes |

## Other

- **Enumeration date:** 12/06/2012
- **Last updated:** 06/17/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1386989028 | NPI | SC |
| 01 | — | 1689757007 | NC NPI | NC |