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General NPI Number Information
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NPI Number | 1205885159
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA FOOT & ANKLE ASSOCIATES PA
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 1602 DOCTORS CIR
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City | WILMINGTON
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State | NC
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Zip | 28401-7406
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Country | US
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Telephone | 910-343-8889
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Fax | 910-343-9990
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Provider Business Mailing Address
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Address Line | 1602 DOCTORS CIR
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City | WILMINGTON
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State | NC
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Zip | 28401-7406
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Country | US
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Telephone | 910-343-8889
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Fax | 910-343-9990
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. KATHY N WALKER
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Credential |
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Telephone | 910-343-8889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 449
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 230
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License Number State | NC
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