Healthcare Provider Details

I. General information

NPI: 1730220963
Provider Name (Legal Business Name): CECIL DWIGHT PRICE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WAKE FOREST UNIVERSITY - 1834 REYNOLDA ROAD MACKIE HEALTH CENTER - REYNOLDS GYMNASIUM - WINGATE RD
WINSTON SALEM NC
27106
US

IV. Provider business mailing address

PO BOX 7386 WAKE FOREST UNIVERSITY STUDENT HEALTH SERVICE
WINSTON SALEM NC
27109-7386
US

V. Phone/Fax

Practice location:
  • Phone: 336-758-5218
  • Fax: 336-758-6054
Mailing address:
  • Phone: 336-758-5218
  • Fax: 336-758-6054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30846
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: