Healthcare Provider Details

I. General information

NPI: 1790943017
Provider Name (Legal Business Name): COASTAL FOOT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 STATION ST
JACKSONVILLE NC
28546-6304
US

IV. Provider business mailing address

217 STATION ST
JACKSONVILLE NC
28546-6304
US

V. Phone/Fax

Practice location:
  • Phone: 910-938-6000
  • Fax: 910-938-3618
Mailing address:
  • Phone: 910-938-6000
  • Fax: 910-938-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number222
License Number StateNC

VIII. Authorized Official

Name: DR. VALENTINE T HAMILTON
Title or Position: OWNER
Credential: DPM
Phone: 910-938-6000