Intracoastal Executive Wellness
NPI #1013760172 in Southport, North Carolina
Provider Information
- NPI Number
- 1013760172
- Entity Type
- Organization
- Organization Name
- Intracoastal Executive Wellness
- Primary Specialty
- Internal Medicine
- Enumeration Date
- Apr 9, 2024
- Last Updated
- Apr 9, 2024
Practice Location
- Address
- 606 W WEST ST STE 202
- City
- Southport
- State
- North Carolina
- ZIP Code
- 28461-3850
- Phone
- (910) 286-7420
Authorized Official
- Name
- DR. RICHARD WAYNE HILLIARD JR., DO
- Title
- MEMBER
- Phone
- (910) 286-7420
Specialties & Taxonomy Codes
| Specialty |
|---|
| Internal Medicine |
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