Healthcare Provider Details

I. General information

NPI: 1285288225
Provider Name (Legal Business Name): FAMILY FIRST HEALTH CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 OLEANDER DR STE 102
MYRTLE BEACH SC
29577-5711
US

IV. Provider business mailing address

4612 OLEANDER DR STE 102
MYRTLE BEACH SC
29577-5711
US

V. Phone/Fax

Practice location:
  • Phone: 843-945-8117
  • Fax: 843-945-8124
Mailing address:
  • Phone: 843-945-8117
  • Fax: 843-945-8124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRYSTAL M COATES-GAL
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 843-945-8117