Organization
COASTAL CAROLINA PRIMARY CARE, LLC
Active
Other names
Doc At The Door
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE O. WINNEY (VICE PRESIDENT)
(843) 847-4054
Entity
Organization
Contact information
Practice address
3601 LADSON RD, SUITE 101, LADSON, SC 29456-4304
(843) 821-0733
(843) 821-0925
Mailing address
3601 LADSON RD, SUITE 101, LADSON, SC 29456-4304
(843) 821-0733
(843) 821-0925
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942522719
—
SC
05
—
GP5390
—
SC
Enumeration date
02/22/2010
Last updated
05/05/2010
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