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Organization

COASTAL CAROLINA MULTISPECIALTY ASSOCS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARK PICKETT (VICE-PRESIDENT OF OPERATIONS)
(678) 762-5037
Entity
Organization

Contact information

Practice address
9221 UNIVERSITY BLVD, SUITE 102, NORTH CHARLESTON, SC 29406-9148
(843) 576-0700
(843) 576-0701
Mailing address
9221 UNIVERSITY BLVD, SUITE 102, NORTH CHARLESTON, SC 29406-9148
(843) 576-0700
(843) 576-0701

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GP 4508
SC
Enumeration date
08/23/2006
Last updated
10/31/2007
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