Healthcare Provider Details

I. General information

NPI: 1548254477
Provider Name (Legal Business Name): VIRGIL VICTOR WILLARD II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N LINDSAY ST SUITE 202
HIGH POINT NC
27262-3944
US

IV. Provider business mailing address

1011 N LINDSAY ST SUITE 202
HIGH POINT NC
27262-3944
US

V. Phone/Fax

Practice location:
  • Phone: 336-886-1667
  • Fax: 336-886-5536
Mailing address:
  • Phone: 336-886-1667
  • Fax: 336-886-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number26413
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number26413
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: