Organization
CAPESIDE ADDICTION CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM BEASLEY (CHIEF OPERATING OFFICER)
(910) 791-6767
Entity
Organization
Contact information
Practice address
4889 HIGHWAY 17 BYP S, MYRTLE BEACH, SC 29577-6683
(843) 584-7011
(843) 945-1355
Mailing address
311 4 E JUDGES ROAD, WILMINGTON, NC 28405
(910) 791-6767
(910) 399-2190
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255323622
—
NC
Enumeration date
10/10/2018
Last updated
10/10/2018
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