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
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016UX
BCBS
NC
Enumeration date
03/15/2007
Last updated
07/09/2025
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