Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Coastal Carolinas Integrated Medicine PA

Organization Pain Medicine (Physical Medicine & Rehabilitation) Physician · NPI 1649304239

Coastal Carolinas Integrated Medicine PA is a Pain Medicine (Physical Medicine & Rehabilitation) Physician in Supply, North Carolina. Works from 2 locations. Licensed in North Carolina.

Licensed in
NC
In the registry since
2007
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

10 Doctors Cir Ste 2
Supply, NC 28462-4089
Phone: (910) 755-6060
Fax: (910) 939-1659
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 416 Main St, North Myrtle Beach, SC 29582-3024 — (910) 755-6060

Specialties & licences

Pain Medicine (Physical Medicine & Rehabilitation) Physician (primary) Taxonomy 2081P2900X · Licence 36621 (NC)

Record details

NPI number1649304239
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kenneth Willeford — Owner · (910) 755-6060
NPI enumeratedMarch 15, 2007
Last updated in NPPESJuly 9, 2025
Certification dateJuly 9, 2025
Mailing address10 Doctors Cir, Suite 2, Supply, NC 28462-4089