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General NPI Number Information
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NPI Number | 1659458966
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Entity Type | Organization
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Legal Business Name | COASTAL GYNECOLOGY AND OBSTETRICS PA
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 2093 HENRY TECKLENBURG DR SUITE 304 EAST
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City | CHARLESTON
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State | SC
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Zip | 29414-5741
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Country | US
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Telephone | 843-571-0200
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Fax | 866-848-8485
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Provider Business Mailing Address
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Address Line | PO BOX 81060
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City | CHARLESTON
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State | SC
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Zip | 29416-1060
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Country | US
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Telephone | 843-571-0200
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Fax | 866-848-8485
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. HARRY WADE BOATWRIGHT
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Credential | M.D.
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Telephone | 843-571-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 12402
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License Number State | SC
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