Waccamaw Plastic Surgery, LLC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

WACCAMAW PLASTIC SURGERY, LLC

Practice address

917 Medical Cir
Myrtle Beach, SC 29572-4116

Phone

(843) 449-0453

Fax

(843) 449-9531

NPI assigned

Sep 6, 2022

Last updated

Sep 6, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brandon J Coakley, MDNPI 1992065858

Title

Owner

Phone

(843) 449-0453

Specialties & licenses 3

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brandon James Coakley, MD

  • MOHS-Micrographic Surgery Physician
  • Myrtle Beach, SC
  • NPI 1992065858
  Authorized official Same address or phone
• Stephen Hammond, M.D

  • Dermatopathology Physician
  • Myrtle Beach, SC
  • NPI 1851553523
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662422400000",
    "number": "1790406189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 MEDICAL CIR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724116",
            "telephone_number": "843-449-0453",
            "fax_number": "843-449-9531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 MEDICAL CIR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724116",
            "telephone_number": "843-449-0453",
            "fax_number": "843-449-9531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACCAMAW PLASTIC SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-06",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A",
        "authorized_official_last_name": "COAKLEY",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-449-0453",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Waccamaw Community Care, LLC
• Waccamaw Dermatology and Plastic Surgery
• Waccamaw Dermatology, LLC
• Waccamaw Medical Transport, Inc. (Lifestar)
• Waccamaw Medical Transport, Inc. (Lifestar)
• Rubina Wadud, MD
• Cheyenne Lark Wagner
• Wal-Mart Stores East LP (Walmart Pharmacy 10-2870)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0574)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2712)

• Plastic Surgery Physician in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Plastic Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.