# COASTAL UROLOGY CENTER, PA

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

## Provider details

- **NPI number:** 1528010378
- **Authorized official:** DR. TIMOTHY JOSEPH QUILLEN M.D. (PRESIDENT)
- **Authorized official phone:** (843) 347-8765

## Contact information

- **Practice address:** 394 SINGLETON RIDGE RD, CONWAY, SC 29526-9150
- **Practice address phone:** (843) 347-8765
- **Practice address fax:** (843) 347-3466
- **Mailing address:** 394 SINGLETON RIDGE RD, CONWAY, SC 29526-9150
- **Mailing address phone:** (843) 347-8765
- **Mailing address fax:** (843) 347-3466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/17/2006
- **Last updated:** 08/22/2020