Organization
COASTAL CAROLINA REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ALEXANDER NICHOLSON MD (PRESIDENT)
(843) 693-2346
Entity
Organization
Contact information
Practice address
316 CALHOUN ST, CHARLESTON, SC 29401-1113
(843) 724-2097
(843) 724-1995
Mailing address
PO BOX 80128, CHARLESTON, SC 29416-0128
(843) 724-2097
(843) 724-1995
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
15656
SC
Other
Enumeration date
03/26/2013
Last updated
04/30/2014
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