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General NPI Number Information
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NPI Number | 1790943017
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Entity Type | Organization
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Legal Business Name | COASTAL FOOT CENTER
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 217 STATION ST
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6304
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Country | US
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Telephone | 910-938-6000
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Fax | 910-938-3618
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Provider Business Mailing Address
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Address Line | 217 STATION ST
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6304
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Country | US
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Telephone | 910-938-6000
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Fax | 910-938-3618
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Authorized Official
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Title or Position | OWNER
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Name | DR. VALENTINE T HAMILTON
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Credential | DPM
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Telephone | 910-938-6000
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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 | 222
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License Number State | NC
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