Provider Demographics
NPI:1841608155
Name:PRICE, STEPHEN KOTY (AA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:KOTY
Last Name:PRICE
Suffix:
Gender:M
Credentials:AA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 LANDING RD APT C
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-2999
Mailing Address - Country:US
Mailing Address - Phone:843-845-7619
Mailing Address - Fax:
Practice Address - Street 1:211 LANDING RD APT C
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-2999
Practice Address - Country:US
Practice Address - Phone:843-845-7619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367H00000X
SCAA43367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant