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General NPI Number Information
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NPI Number | 1821394800
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA HEALTH CARE PA
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 975 NEWMAN RD
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City | NEW BERN
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State | NC
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Zip | 28562-5252
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Country | US
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Telephone | 252-514-6644
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Fax | 252-638-2626
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Provider Business Mailing Address
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Address Line | PO BOX 12248
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City | NEW BERN
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State | NC
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Zip | 28561-2248
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Country | US
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Telephone | 252-514-6644
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Fax | 252-638-2626
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Authorized Official
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Title or Position | CEO
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Name | STEPHEN W. NUCKOLLS
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Credential |
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Telephone | 252-514-6685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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