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General NPI Number Information
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NPI Number | 1053415737
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA FAMILY MEDICINE
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1010 MEDICAL CENTER DR STE 240
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City | HARDEEVILLE
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State | SC
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Zip | 29927-3448
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Country | US
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Telephone | 843-784-8300
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Fax | 843-784-8304
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Provider Business Mailing Address
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Address Line | PO BOX 1633
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City | HARDEEVILLE
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State | SC
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Zip | 29927-1633
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Country | US
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Telephone | 843-784-8300
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Fax | 843-784-8304
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Authorized Official
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Title or Position | PRESIDENT
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Name | HEATHER M HUTCHINGS
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Credential | DO
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Telephone | 843-784-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 842
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License Number State | SC
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