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General NPI Number Information
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NPI Number | 1932641313
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Entity Type | Organization
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Legal Business Name | ATLANTIC COAST ANESTHESIA SERVICES P.C.
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 809 82ND PKWY
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City | MYRTLE BEACH
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State | SC
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Zip | 29572-4607
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Country | US
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Telephone | 843-692-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 SAINT MATTHEWS RD
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City | ORANGEBURG
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State | SC
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Zip | 29118-1442
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Country | US
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Telephone | 865-293-5676
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Fax | 865-291-3239
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Authorized Official
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Title or Position | DIRECTOR
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Name | STACEY MICHELLE WILSON
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Credential |
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Telephone | 865-985-7114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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