Organization
COASTAL CAROLINA ENT, DO, PA
Active
Parent organization
COASTAL CAROLINA ENT, DO, PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
COASTAL CAROLINA ENT, DO, PA
Authorized official
MS. WENDY C. PARIS CPC (INSURANCE/BILLING SPECIALIST)
(910) 914-0540
Entity
Organization
Contact information
Practice address
3806 SAWTELL RD, LITTLE RIVER, SC 29566-7873
(843) 663-9090
(843) 663-9091
Mailing address
302 LIBERTY ST, WHITEVILLE, NC 28472-3714
(910) 914-0540
(910) 914-0640
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
DO 1480
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1386989028
NPI
SC
01
—
1689757007
NC NPI
NC
Enumeration date
12/06/2012
Last updated
06/17/2024
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