Organization
WACCAMAW DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON J. COAKLEY MD (MANAGING PARTNER)
(843) 449-0453
Entity
Organization
Contact information
Practice address
917 MEDICAL CIRCLE, MYRTLE BEACH, SC 29572
(843) 449-0453
(843) 282-1910
Mailing address
917 MEDICAL CIRCLE, MYRTLE BEACH, SC 29572
(843) 449-0453
(843) 282-1910
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1554
—
SC
Enumeration date
05/31/2006
Last updated
03/22/2022
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