# CAROLINA COAST PRIMARY MEDICINE

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

## Provider details

- **NPI number:** 1669401964
- **Authorized official:** MRS. BERTHA1 TAYLOR- MILLER FNP (MANAGER)
- **Authorized official phone:** (910) 296-1087

## Contact information

- **Practice address:** 275 N NC 24 & 50 HWY, KENANSVILLE, NC 28349-0148
- **Practice address phone:** (910) 296-1087
- **Practice address fax:** (910) 296-1086
- **Mailing address:** PO BOX 148, KENANSVILLE, NC 28349-0148
- **Mailing address phone:** (910) 296-1087
- **Mailing address fax:** (910) 296-1086

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/01/2006
- **Last updated:** 11/01/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 11515 | BCBS | NC |
| 05 | — | 5900323 | — | NC |