Healthcare Provider Details

I. General information

NPI: 1578697496
Provider Name (Legal Business Name): COASTAL PODIATRY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SAWTELL RD
LITTLE RIVER SC
29566-7873
US

IV. Provider business mailing address

8141 ROURK ST
MYRTLE BEACH SC
29572-4128
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-8079
  • Fax: 843-497-6147
Mailing address:
  • Phone: 843-449-8079
  • Fax: 843-497-6147

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: DR. SCOTT A HAMILTON
Title or Position: DOCTOR
Credential: DPM
Phone: 843-449-8079