Organization
COASTAL WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD FRANCIS CONGDON M.D. (MANAGING PHYSICIAN)
(888) 467-1117
Entity
Organization
Contact information
Practice address
4955 HIGHWAY 17 BYP S, MYRTLE BEACH, SC 29577-6684
(888) 403-2444
(855) 818-2168
Mailing address
4955 HIGHWAY 17 BYP S, MYRTLE BEACH, SC 29577-6684
(888) 403-2444
(855) 818-2168
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP7038
—
SC
Enumeration date
03/14/2008
Last updated
03/06/2019
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