| Organization Name: | COASTAL CAROLINAS INTEGRATED MEDICINE PA |
| NPI Number: | 1649304239 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNETH LEE WILLEFORD (OWNER) |
| Mailing Address: | 10 Doctors Cir Suite 2 Supply |
| State: | NC US |
| Postal Code: | 284624089 |
| Phone Number: | 9107556060 |
| Fax Number: | 9107556061 |
| NPI Enumeration Date: | 03/15/2007 |
| NPI Last Update Date: | 08/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2081P2900X |
| License Number: | 36621 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Physical Medicine & Rehabilitation |
| Taxonomy Specialization: | Pain Medicine |
| Taxonomy Definition: | A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |