# COASTAL CAROLINA INTERNAL MEDICINE, PA

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

## Provider details

- **NPI number:** 1881619740
- **Authorized official:** MRS. MITZI M ROS R.N (OFFICE MANAGER)
- **Authorized official phone:** (910) 937-0008

## Contact information

- **Practice address:** 2420 HENDERSON DR, JACKSONVILLE, NC 28546-5254
- **Practice address phone:** (910) 937-0008
- **Practice address fax:** (910) 937-0098
- **Mailing address:** 2420 HENDERSON DR, JACKSONVILLE, NC 28546-5254
- **Mailing address phone:** (910) 937-0008
- **Mailing address fax:** (910) 937-0098

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | 200200443 | NC | Yes |

## Other

- **Enumeration date:** 07/13/2006
- **Last updated:** 10/30/2019