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General NPI Number Information
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NPI Number | 1982246633
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Entity Type | Organization
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Legal Business Name | SOUTHERN COAST SPECIALISTS, LLC
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 16 OKATIE CENTER BLVD S STE 201
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City | BLUFFTON
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State | SC
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Zip | 29909-7544
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Country | US
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Telephone | 843-870-8127
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Fax |
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Provider Business Mailing Address
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Address Line | 9565 HIGHWAY 78 BLDG 100
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City | LADSON
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State | SC
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Zip | 29456-4118
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CODY L PALMER
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Credential |
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Telephone | 843-870-8127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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