# COASTAL CAROLINA REHABILITATION, LLC

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

## Provider details

- **NPI number:** 1407198674
- **Authorized official:** JOHN ALEXANDER NICHOLSON MD (PRESIDENT)
- **Authorized official phone:** (843) 693-2346

## Contact information

- **Practice address:** 316 CALHOUN ST, CHARLESTON, SC 29401-1113
- **Practice address phone:** (843) 724-2097
- **Practice address fax:** (843) 724-1995
- **Mailing address:** PO BOX 80128, CHARLESTON, SC 29416-0128
- **Mailing address phone:** (843) 724-2097
- **Mailing address fax:** (843) 724-1995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 15656 | SC | Yes |

## Other

- **Enumeration date:** 03/26/2013
- **Last updated:** 04/30/2014