Provider Demographics
NPI:1598994956
Name:WILLETT, DWIGHT JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:JAMES
Last Name:WILLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:BAKERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28705-0027
Mailing Address - Country:US
Mailing Address - Phone:828-688-2104
Mailing Address - Fax:828-688-1334
Practice Address - Street 1:11728 S 226 HWY
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-8954
Practice Address - Country:US
Practice Address - Phone:828-766-7778
Practice Address - Fax:828-688-1334
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01826207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCE5980151Medicare PIN