Provider Demographics
NPI:1457447294
Name:WILLIFORD, KEISHA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:KEISHA
Middle Name:ANN
Last Name:WILLIFORD
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:217 BOBBY JONES EXPRESSWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907
Mailing Address - Country:US
Mailing Address - Phone:706-860-1171
Mailing Address - Fax:706-860-1841
Practice Address - Street 1:217 BOBBY JONES EXPRESSWAY
Practice Address - Street 2:SUITE B
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-860-1171
Practice Address - Fax:706-860-1841
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAOPT002247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist