Provider Demographics
NPI:1962626572
Name:WILLIFORD, KATHRYN K (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:K
Last Name:WILLIFORD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2467 GOLDEN CAMP RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-5515
Mailing Address - Country:US
Mailing Address - Phone:706-790-4440
Mailing Address - Fax:706-922-0252
Practice Address - Street 1:2011 WESTEND DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-5146
Practice Address - Country:US
Practice Address - Phone:706-453-9803
Practice Address - Fax:706-453-0728
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040114208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000666157FMedicaid
GA000666157GMedicaid
GA37BBGZFMedicare ID - Type Unspecified
GA000666157GMedicaid