Basic Information
| Provider Information | |||||||||
| NPI: | 1609004514 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEACOAST NEUROLOGY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3980 HIGHWAY 9 E | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | LITTLE RIVER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295667832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433908310 | ||||||||
| FaxNumber: | 8433908319 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 HIGHWAY 9 E | ||||||||
| Address2: | SUITE 255 | ||||||||
| City: | LITTLE RIVER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295667833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433908310 | ||||||||
| FaxNumber: | 8433908319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2009 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | CAROLYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONSULTANT | ||||||||
| AuthorizedOfficialTelephone: | 9198806406 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LORIS COMMUNITY HOSPITAL DISTRICT | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.