OrganizationActive
Coastal Carolinas Integrated Medicine PA
NPI 1649304239 · Pain Medicine (Physical Medicine & Rehabilitation) Physician · Supply, NC
Provider details
- NPI number
- 1649304239
- Entity type
- Organization
- Primary specialty
- Pain Medicine (Physical Medicine & Rehabilitation) PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Kenneth Willeford, Owner
- License
- 36621 (NC)
Practice location
10 Doctors Cir
Suite 2
Supply, NC 28462-4089
Phone: (910) 755-6060
Fax: (910) 939-1659
Mailing address
10 Doctors Cir
Supply, NC 28462-4089
Registry dates
- Enumerated
- 2007-03-15
- Last updated
- 2025-07-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.