{
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"FirstLineMailingAddress": "10 DOCTORS CIR",
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"MailingAddressFaxNumber": "910-755-6061",
"FirstLinePracticeLocationAddress": "10 DOCTORS CIR",
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"PracticeLocationAddressFaxNumber": "910-939-1659",
"EnumerationDate": "03/15/2007",
"LastUpdateDate": "07/09/2025",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
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"Gender": null,
"AuthorizedOfficialLastName": "WILLEFORD",
"AuthorizedOfficialFirstName": "KENNETH",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2081P2900X",
"TaxonomyName": "Pain Medicine (Physical Medicine & Rehabilitation) Physician",
"LicenseNumber": "36621",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}
}
}