Healthcare Provider Details

I. General information

NPI: 1043133382
Provider Name (Legal Business Name): THE HAVEN DIRECT PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 OLEANDER DR STE 102
MYRTLE BEACH SC
29577-5742
US

IV. Provider business mailing address

1489 BROOKGREEN DR
MYRTLE BEACH SC
29577-5823
US

V. Phone/Fax

Practice location:
  • Phone: 843-213-5800
  • Fax:
Mailing address:
  • Phone: 843-213-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER STANLEY
Title or Position: OWNER
Credential: MD
Phone: 352-408-9040