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General NPI Number Information
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NPI Number | 1467988014
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Entity Type | Individual
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Provider Name | ADAM KENNETH WILLSON M.D
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Gender | Male
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 3700 BARRETT DR STE 300
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City | RALEIGH
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State | NC
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Zip | 27609-7172
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Country | US
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Telephone | 919-782-1806
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Fax | 919-782-4756
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Provider Business Mailing Address
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Address Line | PO BOX 18563
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City | RALEIGH
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State | NC
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Zip | 27619-8563
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Country | US
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Telephone | 919-782-1806
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Fax | 919-782-4756
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 2021-00765
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2021-00765
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License Number State | NC
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