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General NPI Number Information
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NPI Number | 1306801295
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA CARDIOLOGY, P.A.
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 850 W H SMITH BLVD
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City | GREENVILLE
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State | NC
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Zip | 27834-3763
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Country | US
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Telephone | 252-758-3211
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Fax | 252-758-1811
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Provider Business Mailing Address
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Address Line | 850 W H SMITH BLVD
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City | GREENVILLE
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State | NC
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Zip | 27834-3763
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Country | US
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Telephone | 252-758-3211
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Fax | 252-758-1811
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MS. KAREN L WATERFIELD
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Credential |
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Telephone | 252-758-3211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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