Individual
SUSAN ANN KIDWELL WILLIFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-4324
(336) 716-5599
Mailing address
1701 WESTCHESTER DRIVE, SUITE 850, HIGH POINT, NC 27262-7254
(336) 802-2400
(336) 802-2001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
29454
NC
207RH0003X
Hematology & Oncology Physician
Primary
29454
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110122233
RR MEDICARE
NC
05
—
8988077
—
NC
Enumeration date
07/24/2006
Last updated
09/18/2018
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