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Organization
COASTAL PODIATRY ASSOCIATES PA
Active
Organization
COASTAL PODIATRY ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN E FISHER (PRACTICE ADMINISTRATOR)
(843) 449-8079
Entity
Organization
Contact information
Practice address
3997 MEETING ST, LORIS, SC 29569-3053
(843) 449-8079
(843) 497-6147
Mailing address
8141 ROURK ST, MYRTLE BEACH, SC 29572-4128
(843) 449-8079
(843) 497-6147
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
SC
213ES0103X
Foot & Ankle Surgery Podiatrist
—
SC
213ES0131X
Foot Surgery Podiatrist
—
SC
Other
Enumeration date
07/21/2015
Last updated
09/13/2019
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