Healthcare Provider Details

I. General information

NPI: 1427478908
Provider Name (Legal Business Name): ELIZABETH GREEN WILLIAMS BRAXTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 HIGHLAND OAKS DR STE 100
WINSTON SALEM NC
27103-7105
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-1970
  • Fax: 336-774-8601
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2018-01315
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: