Provider Demographics
NPI:1255393971
Name:PIEDMONT PLASTIC SURGERY, PA
Entity type:Organization
Organization Name:PIEDMONT PLASTIC SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:V
Authorized Official - Last Name:WILLARD
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:336-886-1667
Mailing Address - Street 1:1011 N LINDSAY ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3944
Mailing Address - Country:US
Mailing Address - Phone:336-886-1667
Mailing Address - Fax:336-886-5536
Practice Address - Street 1:1011 N LINDSAY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3944
Practice Address - Country:US
Practice Address - Phone:336-886-1667
Practice Address - Fax:336-886-5536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902376Medicaid
NC7902376Medicaid