Organization
COASTAL CAROLINA MEDICAL CENTER, INC
Active
Other names
COASTAL MEDICAL ASSOCIATES
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL KYLE BURTNETT (SVP OF OUTPATIENT SERVICES, TENET)
(469) 893-2153
Entity
Organization
Contact information
Practice address
10911 NORTH JACOB SMART BLVD, #D, RIDGELAND, SC 29936-2729
(843) 784-3101
(843) 784-5313
Mailing address
PO BOX 741261, ATLANTA, GA 30374-1261
(843) 784-3101
(843) 784-5313
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
02/07/2007
Last updated
06/05/2014
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