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Organization
CAROLINA COAST PRIMARY MEDICINE
Active
Organization
CAROLINA COAST PRIMARY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BERTHA1 TAYLOR- MILLER FNP (MANAGER)
(910) 296-1087
Entity
Organization
Contact information
Practice address
275 N NC 24 & 50 HWY, KENANSVILLE, NC 28349-0148
(910) 296-1087
(910) 296-1086
Mailing address
PO BOX 148, KENANSVILLE, NC 28349-0148
(910) 296-1087
(910) 296-1086
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11515
BCBS
NC
05
—
5900323
—
NC
Enumeration date
07/01/2006
Last updated
11/01/2012
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