Provider Demographics
NPI:1518102193
Name:CAROLINAS COASTAL HEALTH, PC
Entity Type:Organization
Organization Name:CAROLINAS COASTAL HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WELLINGTON
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-352-2396
Mailing Address - Street 1:1003 OLDE WATERFORD WAY
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4167
Mailing Address - Country:US
Mailing Address - Phone:910-338-0588
Mailing Address - Fax:
Practice Address - Street 1:1003 OLDE WATERFORD WAY
Practice Address - Street 2:SUITE 1-C
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4167
Practice Address - Country:US
Practice Address - Phone:910-338-0588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2263829EOtherMEDICARE
NC1322HOtherBLUE CROSS BLUE SHIELD