Healthcare Provider Details

I. General information

NPI: 1063974319
Provider Name (Legal Business Name): WILLIAM LOUIS WARDELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 N MAIN ST
TARBORO NC
27886-1921
US

IV. Provider business mailing address

2906 N MAIN ST
TARBORO NC
27886-1921
US

V. Phone/Fax

Practice location:
  • Phone: 252-823-7212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2026-04253
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number345088
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: