Healthcare Provider Details

I. General information

NPI: 1548231772
Provider Name (Legal Business Name): WILLIAM H STURGILL III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/25/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 KIMEL PARK DR DBA WINSTON-SALEM HEALTHCARE
WINSTON SALEM NC
27103-6951
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-1006
  • Fax: 336-718-1296
Mailing address:
  • Phone: 336-718-1006
  • Fax: 336-718-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number9901042
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: