Healthcare Provider Details

I. General information

NPI: 1598007908
Provider Name (Legal Business Name): ERIC CLAYTON COUGHLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WILLIAM H. JOHNSON STREET SUITE 200
FLORENCE SC
29506-2776
US

IV. Provider business mailing address

P. O. BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-7500
  • Fax: 843-777-7533
Mailing address:
  • Phone: 843-777-5098
  • Fax: 843-777-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number40617
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: