Provider Demographics
NPI:1932653649
Name:WARD, WILLIAM M (MS, RD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:WARD
Suffix:
Gender:M
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N LIBERTY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2911
Mailing Address - Country:US
Mailing Address - Phone:757-814-0752
Mailing Address - Fax:
Practice Address - Street 1:222 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5313
Practice Address - Country:US
Practice Address - Phone:757-814-0752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004961133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered