Organization
COASTAL CAROLINA OB GYN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA WHITESTONE (INSURANCE BILLING CLERK)
(843) 349-0100
Entity
Organization
Contact information
Practice address
620 SINGLETON RIDGE RD, CONWAY, SC 29526-9154
(843) 349-0100
(843) 349-0104
Mailing address
PO BOX 50754, MYRTLE BEACH, SC 29579
(843) 349-0100
(843) 349-0104
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
115921
SC
207V00000X
Obstetrics & Gynecology Physician
23311
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3863
—
SC
Enumeration date
06/02/2006
Last updated
03/10/2015
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