# COASTAL CAROLINA UROLOGY GROUP LLC

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

## Provider details

- **NPI number:** 1477612703
- **Authorized official:** JEANINE SAWLER (PRACTICE MANAGER)
- **Authorized official phone:** (843) 524-7607

## Contact information

- **Practice address:** 1055 RIBAUT RD, SUITE 10, BEAUFORT, SC 29902-5423
- **Practice address phone:** (843) 524-7607
- **Practice address fax:** (843) 524-6737
- **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 | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 01/14/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CG7000 | MCRR PIN | SC |