DR. PHILLIP MABON WILLIFORD


Address: 4618 Country Club Rd, Winston Salem, NC 27104-3520
Phone: 3367162255

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

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

Other Providers PHILLIP WILLIFORD

NPI Name Taxonomy Address Enumeration
1922386804 Phillip Andrew Williford Physician Assistant 535 Wellington Way Ste 330, Lexington, KY 40503-1331 2011-07-27

Office Location

Street Address 4618 COUNTRY CLUB RD
City WINSTON SALEM
State NC
Zip Code 27104-3520

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 207ND0101X
Grouping Allopathic & Osteopathic Physicians
Classification Dermatology
Specialization MOHS-Micrographic Surgery

Taxonomy Definition

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/

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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
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Competitor

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City WINSTON SALEM
Zip Code 27104

Improve Information

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Dataset Information

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.

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