Provider Demographics
NPI:1629282744
Name:COASTAL CAROLINA PODIATRY INC
Entity Type:Organization
Organization Name:COASTAL CAROLINA PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HAL
Authorized Official - Last Name:HATCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-851-9069
Mailing Address - Street 1:299 MIDLAND PKWY # B
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8104
Mailing Address - Country:US
Mailing Address - Phone:843-851-9069
Mailing Address - Fax:843-871-8248
Practice Address - Street 1:299 MIDLAND PKWY # B
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8104
Practice Address - Country:US
Practice Address - Phone:843-851-9069
Practice Address - Fax:843-871-8248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0556213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF0094OtherRR MEDICARE
SCPD5561Medicaid
SCCM2497OtherRAIL ROAD
SC=========OtherBCBS
SC=========OtherCHAMPUS
SCPD5561Medicaid
DF0094OtherRR MEDICARE