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Organization
COASTAL CAROLINA PRIMARY CARE, LLC
Active
Organization
COASTAL CAROLINA PRIMARY CARE, LLC
Active
Other names
Doc At The Door
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE O. WINNEY (VICE PRESIDENT)
(843) 847-4054
Entity
Organization
Contact information
Practice address
3601 LADSON RD, SUITE 101, LADSON, SC 29456-4304
(843) 821-0733
(843) 821-0925
Mailing address
3601 LADSON RD, SUITE 101, LADSON, SC 29456-4304
(843) 821-0733
(843) 821-0925
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942522719
—
SC
05
—
GP5390
—
SC
Enumeration date
02/22/2010
Last updated
05/05/2010
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