Coastal Family Medicine
Legal Medicine in Conway, SC(View on Map)
Legal Business Name
Coastal Family Medicine
NPI Number
1548459597
NPI Type
Organization
Enumeration Date
10/16/2007
Specialties
(Taxonomies)Licenses
State
South Carolina
License Number
MD 7055
Contact
Information
Purpose
Mailing
Location
Address
8014 MYRTLE TRACE DR
8014 MYRTLE TRACE DR
City
Conway
Conway
State
SC
SC
Postal Code
29526-8945
29526-8945
Country
US
US
Telephone Number
(843) 347-7224
(843) 347-7224
Authorized Official
Name
Jonathan Dieter
Title or Position
OWNER
Telephone Number
(843) 347-7224
Identifiers
Identifier
2958
PC4269
Identifier State
SC
SC
Identifier Issuer
MEDICARE PROVIDER NUMBER
MEDICAID PROVIDER NUMBER
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 10/17/2007