Organization
WACCAMAW PLASTIC SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON J COAKLEY MD (OWNER)
(843) 449-0453
Entity
Organization
Contact information
Practice address
917 MEDICAL CIR, MYRTLE BEACH, SC 29572-4116
(843) 449-0453
(843) 449-9531
Mailing address
917 MEDICAL CIR, MYRTLE BEACH, SC 29572-4116
(843) 449-0453
(843) 449-9531
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
09/06/2022
Last updated
09/06/2022
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