Organization
COASTAL PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BOBBIE J ARD (PRACTICE MANAGE)
(843) 347-4677
Entity
Organization
Contact information
Practice address
8030 MYRTLE TRACE DR, CONWAY, SC 29526-8945
(843) 347-4677
(843) 347-4678
Mailing address
8030 MYRTLE TRACE DR, CONWAY, SC 29526-8945
(843) 347-4677
(843) 347-4678
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC0593
—
SC
Enumeration date
07/23/2014
Last updated
07/21/2022
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