Individual provider Active NPI

William Jeffery Marshall, M.D.

  • Psychiatry Physician
  • Clemmons, NC
National Provider Identifier
1104992627
Registry record updated Nov 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
28539 Issued in NC
Practice address
2255 Lewisville Clemmons Rd Ste E
Clemmons, NC 27012-7460
Phone
(336) 766-0505
Fax
(336) 766-0553
NPI assigned
Nov 27, 2006
Last updated
Nov 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 28539 NC Primary

Addresses

Primary practice location

2255 Lewisville Clemmons Rd Ste E
Clemmons, NC 27012-7460

Mailing address

2255 Lewisville Clemmons Rd Ste E
Clemmons, NC 27012-7460
Phone (336) 766-0505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111013000082 NC Practitioner - Psychiatry 7810169042 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Wake Forest University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2255 Lewisville Clemmons Rd
Suite E
Clemmons, NC 27012-7460
Phone (336) 766-0505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
28539NCMDAddiction (Substance Use Disorder) Counselor

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762387200000",
    "number": "1104992627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 LEWISVILLE CLEMMONS RD STE E",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270127460",
            "telephone_number": "336-766-0505",
            "fax_number": "336-766-8586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 LEWISVILLE CLEMMONS RD STE E",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270127460",
            "telephone_number": "336-766-0505",
            "fax_number": "336-766-0553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "WILLIAM",
        "middle_name": "JEFFERY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "28539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clemmons, NC

Sources for this page

Verify at the official NPI Registry.