# COASTAL CAROLINAS INTEGRATED MEDICINE PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649304239
- **Authorized official:** DR. KENNETH LEE WILLEFORD M.D. (OWNER)
- **Authorized official phone:** (910) 755-6060

## Contact information

- **Practice address:** 10 DOCTORS CIR, SUITE 2, SUPPLY, NC 28462-4089
- **Practice address phone:** (910) 755-6060
- **Practice address fax:** (910) 939-1659
- **Mailing address:** 10 DOCTORS CIR, SUITE 2, SUPPLY, NC 28462-4089
- **Mailing address phone:** (910) 755-6060
- **Mailing address fax:** (910) 755-6061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 36621 | NC | Yes |

## Other

- **Enumeration date:** 03/15/2007
- **Last updated:** 07/09/2025