Healthcare Provider Details

I. General information

NPI: 1942320312
Provider Name (Legal Business Name): R E WILLIFORD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 FOUST STREET
ASHEBORO NC
27203
US

IV. Provider business mailing address

PO BOX 788
GREENSBORO NC
27402-0788
US

V. Phone/Fax

Practice location:
  • Phone: 336-633-0407
  • Fax: 336-633-0410
Mailing address:
  • Phone: 336-343-7026
  • Fax: 336-633-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9700286
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TARSHIA DONNELL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 336-633-0407