Healthcare Provider Details

I. General information

NPI: 1295906816
Provider Name (Legal Business Name): COASTAL GASTROENTEROLOGY & HEPATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 ASHLEY RIVER RD
CHARLESTON SC
29407-5902
US

IV. Provider business mailing address

PO BOX 31297
CHARLESTON SC
29417-1297
US

V. Phone/Fax

Practice location:
  • Phone: 843-556-1285
  • Fax: 843-556-1286
Mailing address:
  • Phone: 843-556-1285
  • Fax: 843-556-1286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number21101
License Number StateSC

VIII. Authorized Official

Name: DR. JOHN DAVID BOHLER
Title or Position: OWNER
Credential: M.D.
Phone: 843-556-1285