# COASTAL PEDIATRICS

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

## Provider details

- **NPI number:** 1982012829
- **Authorized official:** MS. BOBBIE J ARD (PRACTICE MANAGE)
- **Authorized official phone:** (843) 347-4677

## Contact information

- **Practice address:** 8030 MYRTLE TRACE DR, CONWAY, SC 29526-8945
- **Practice address phone:** (843) 347-4677
- **Practice address fax:** (843) 347-4678
- **Mailing address:** 8030 MYRTLE TRACE DR, CONWAY, SC 29526-8945
- **Mailing address phone:** (843) 347-4677
- **Mailing address fax:** (843) 347-4678

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | SC | Yes |

## Other

- **Enumeration date:** 07/23/2014
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | PC0593 | — | SC |