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Organization
COASTAL CAROLINAS INTEGRATED MEDICINE PA
Active
Organization
COASTAL CAROLINAS INTEGRATED MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH LEE WILLEFORD M.D. (OWNER)
(910) 755-6060
Entity
Organization
Contact information
Practice address
10 DOCTORS CIR, SUITE 2, SUPPLY, NC 28462-4089
(910) 755-6060
(910) 939-1659
Mailing address
10 DOCTORS CIR, SUITE 2, SUPPLY, NC 28462-4089
(910) 755-6060
(910) 755-6061
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
36621
NC
Other
Enumeration date
03/15/2007
Last updated
07/09/2025
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