Healthcare Provider Details

I. General information

NPI: 1932641313
Provider Name (Legal Business Name): ATLANTIC COAST ANESTHESIA SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

3000 SAINT MATTHEWS RD
ORANGEBURG SC
29118-1442
US

V. Phone/Fax

Practice location:
  • Phone: 843-692-1000
  • Fax:
Mailing address:
  • Phone: 865-293-5676
  • Fax: 865-291-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: STACEY MICHELLE WILSON
Title or Position: DIRECTOR
Credential:
Phone: 865-985-7114