| Organization Name: | COASTAL CAROLINA FOOT & ANKLE ASSOCIATION PA |
| NPI Number: | 1639336027 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHY N WALKER (PRACTICE ADMINISTRATOR) |
| Mailing Address: | 114 N Norwood St Wallace |
| State: | NC US |
| Postal Code: | 284662730 |
| Phone Number: | 9102853362 |
| Fax Number: | 9102856683 |
| NPI Enumeration Date: | 05/22/2008 |
| NPI Last Update Date: | 09/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | 449 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |