DR. PHILLIP MABON WILLIFORD (NPI# 1518943943) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1518943943 |
Entity Type | Individual |
Full Name | DR. PHILLIP MABON WILLIFORD |
Credential | MD |
Practice Address |
4618 Country Club Rd Winston Salem NC 27104-3520 |
Mailing Address |
Po Box 344 Winston Salem NC 27102-0344 |
Practice Telephone | 3367162255 |
Practice Fax Number | 3367166761 |
Mailing Telephone | 3367162255 |
Mailing Fax Number | 3367166761 |
Enumeration Date | 2005-12-19 |
Last Update Date | 2010-11-15 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
26483 | NC | Allopathic & Osteopathic Physicians |
N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
26483 | NC | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MEDCOST | 64002 | 01 | |
RR MEDICARE | 70016802 | 01 | |
SC | N26483 | 05 | |
NC | 8988074 | 05 | |
BCBS | 88074 | 01 | |
PARTNERS | 5552 | 01 | |
WV | 2005036000 | 05 | |
VA | 5940478 | 05 | |
AETNA | 4671710 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1922386804 | Phillip Andrew Williford | Physician Assistant | 535 Wellington Way Ste 330, Lexington, KY 40503-1331 | 2011-07-27 |
Street Address |
4618 COUNTRY CLUB RD |
City | WINSTON SALEM |
State | NC |
Zip Code | 27104-3520 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720063175 | Steven Richard Feldman | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2005-12-08 |
1487213047 | Diana Isabel Munoz Ali | Nurse Practitioner | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2019-06-07 |
1629544689 | Kimberly Kincaid Mcpeeks | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2018-10-17 |
1861842031 | Leonora Culp Bomar | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2016-06-17 |
1912392903 | Melissa Brooke Hoffman | Student in an Organized Health Care Education/Training Program | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2015-04-06 |
1083031090 | Jessica Alexis Savas | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2014-03-27 |
1164779997 | Amber Brewer Keller | Physician Assistant | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2012-08-10 |
1629272455 | William Wei-ting Huang | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2007-06-14 |
1841228335 | Adele Clark | Physician Assistant | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2006-06-30 |
1316923360 | Joseph Lucius Jorizzo | Dermatology | 4618 Country Club Rd, Winston Salem, NC 27104-3520 | 2005-12-21 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1447807664 | Cameron Grant Ford | Psychologist | 614 Country Club Road, Winston-salem, NC 27104 | 2019-08-22 |
1104310374 | Novant Medical Group, Inc. | Internal Medicine | 4937 Old Country Club Rd, Winston Salem, NC 27104 | 2018-06-20 |
1982100509 | Dillon James Magalski | Student in an Organized Health Care Education/Training Program | Piedmont Plaza 1, 1920 West First Street, Wake Forest Baptist Medical Center, Winston-salem, NC 27104 | 2018-04-03 |
1891290144 | Breann M Poling | Student in an Organized Health Care Education/Training Program | Wake Forest Baptist Medical Center, Department Of, Family Medicine Piedmont Plaza I 1920 West First Street, Winston Salem, NC 27104 | 2018-03-28 |
1689178600 | Christopher Vasil | Student in an Organized Health Care Education/Training Program | Piedmont Plaza I, 1920 West First Street, Department of Family Medicine, Winston Salem, NC 27104 | 2018-03-23 |
1407379126 | April Lynn Lowe | Registered Nurse | 940 N Peace Haven Rd, Winstonsalem, NC 27104 | 2017-07-25 |
1164950804 | Donald Joyce | Student in an Organized Health Care Education/Training Program | 1920 West First St, Piedmont Plaza I Building, 3rd Floor, Winston-salem, NC 27104 | 2017-05-25 |
1255867289 | Benjamin Hansen | Pharmacist | 2150 Country Club Rd Ste 300, Winston Salem, NC 27104 | 2017-05-11 |
1770020976 | Jane Reed | Physical Medicine & Rehabilitation | 2627 E Greenbrier Road, Winston Salem, NC 27104 | 2017-01-25 |
1053728261 | Ashraf Alsaedi | Pharmacist | 1659 Stratford Rd Nw, Winston Salem, NC 27104 | 2014-07-20 |
Find all providers in zip 27104 |
Taxonomy Code | 207ND0101X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Dermatology |
Specialization | MOHS-Micrographic Surgery |
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1245415132 | Daniel J Pearce | Dermatology | 1450 Professional Park Dr, Suite 150, Winston Salem, NC 27103-1300 | 2008-01-09 |
1508046053 | Forsyth Medical Hospital, Inc | Dermatology | 175 Kimel Park Dr, Dba Winston-salem Healthcare, Winston Salem, NC 27103-6951 | 2007-11-13 |
1588622393 | Barry Leshin | Dermatology | 1450 Professional Park Dr, Ste 150, Winston Salem, NC 27103 | 2006-05-02 |
1164480927 | John G. Albertini | Dermatology | 1450 Professional Park Dr, Ste 150, Winston Salem, NC 27103-1300 | 2006-05-02 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942713052 | Vieta Dermatology, Pllc | Dermatology | 289 Olmsted Blvd Ste 5, Pinehurst, NC 28374-8730 | 2017-11-10 |
1245751403 | Bluewater Dermatology and Skin Cancer Center Pa | Dermatology | 814 Spivey Rd, Whiteville, NC 28472-8736 | 2017-06-28 |
1831330893 | Landon Everett Stigall | Dermatology | 6752 Rock Spring Rd Ste 201, Wilmington, NC 28405 | 2009-03-20 |
1780772541 | Jenny L. Stone | Dermatology | 203 Mocksville Ave Ste B, Salisbury, NC 28144-3360 | 2006-10-10 |
1528035722 | Marc Ronald Carruth | Dermatology | 2615 E 7th St, Charlotte, NC 28204-4376 | 2006-03-07 |
1215902663 | Frederick Walter Gourdin | Dermatology | 78 Long Shoals Rd, Arden, NC 28704-7782 | 2006-02-21 |
1508846403 | Rajat Varma | Dermatology | 410 Market St Ste 400, Unc Dept of Dermatology, Chapel Hill, NC 27516-4061 | 2006-01-18 |
1437130523 | Greg Edwin Viehman | Dermatology | 710 Military Cutoff Rd, Suite 200, Wilmington, NC 28405-2375 | 2005-11-07 |
1598759482 | Eastern Dermatology, P.a. | Dermatology | 420 Spring Forest Rd, Greenville, NC 27834-7244 | 2005-09-07 |
1285636076 | Charles S Johnson | Dermatology | 315 19th St Se, Hickory, NC 28602-4230 | 2005-08-11 |
Find all providers with the same taxonomy |
City | WINSTON SALEM |
Zip Code | 27104 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.