Healthcare Provider Details

I. General information

NPI: 1881527109
Provider Name (Legal Business Name): COASTAL FOOT & ANKLE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 TOWNE DR
BLUFFTON SC
29910-4201
US

IV. Provider business mailing address

1050 FORDING ISLAND RD STE C
BLUFFTON SC
29910-8667
US

V. Phone/Fax

Practice location:
  • Phone: 910-382-8480
  • Fax:
Mailing address:
  • Phone: 910-382-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAUREN THORNBERRY
Title or Position: OWNER
Credential: DPM
Phone: 910-382-8480