Individual
DR. LESLIE WILEY NIFONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
115 HEART DR, GREENVILLE, NC 27834-8982
(252) 744-2187
(252) 744-3542
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
98-00988
NC
208600000X
Surgery Physician
Primary
9800988
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366858086
—
NC
01
—
1897F
BCBS NC
NC
Enumeration date
07/02/2014
Last updated
02/23/2024
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