Provider Demographics
NPI:1972941649
Name:COATES-GAL, CHRYSTAL M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRYSTAL
Middle Name:M
Last Name:COATES-GAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 OLEANDER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5711
Mailing Address - Country:US
Mailing Address - Phone:843-945-8117
Mailing Address - Fax:843-945-8124
Practice Address - Street 1:4612 OLEANDER DR STE 102
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5711
Practice Address - Country:US
Practice Address - Phone:843-945-8117
Practice Address - Fax:843-945-8124
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37846207Q00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC378460Medicaid