# COASTAL CAROLINA ENT

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

## Provider details

- **NPI number:** 1760226419
- **Authorized official:** JODI KINKEAD (OFFICE ADMINISTRATOR)
- **Authorized official phone:** (843) 663-9090

## Contact information

- **Practice address:** 3806 SAWTELL RD, LITTLE RIVER, SC 29566-7873
- **Practice address phone:** (843) 663-9090
- **Practice address fax:** (843) 663-9091
- **Mailing address:** 3806 SAWTELL RD, LITTLE RIVER, SC 29566-7873
- **Mailing address phone:** (846) 663-9090
- **Mailing address fax:** (843) 663-9091

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | NULL | Yes |
| 207Y00000X | Otolaryngology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/19/2024
- **Last updated:** 06/19/2024