Organization
COASTAL PEDIATRIC ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM MCLAURIN GRAHAM MD (PRESIDENT)
(843) 573-2535
Entity
Organization
Contact information
Practice address
1952 LONG GROVE DR, SUITE 202, MOUNT PLEASANT, SC 29464-7579
(843) 284-4262
Mailing address
2051 CHARLIE HALL BLVD, CHARLESTON, SC 29414-5834
(843) 266-4769
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
18368
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4680
—
SC
05
—
GP4716
—
SC
Enumeration date
03/30/2011
Last updated
02/22/2017
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