Individual provider Active NPI

Prerana Aghamkar Williamson, MD

  • Pediatric Gastroenterology Physician
  • Winston Salem, NC
National Provider Identifier
1114344207
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
2020-01643 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-3818
Phone
(336) 713-4500
Fax
(336) 713-4501
NPI assigned
Mar 26, 2014
Last updated
Nov 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X 2020-01643 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-3818

Mailing address

100 Kimel Forest Dr
Winston Salem, NC 27103-6074

Other practice location 1

2311 Lewisville Clemmons Rd
Clemmons, NC 27012-8905
Phone (336) 713-4500

Other practice location 2

571 S Floyd St
Suite 412
Louisville, KY 40202-3818
Phone (502) 629-8828

Other practice location 3

3020 Childrens Way # Mc5030
San Diego, CA 92123-4223
Phone (858) 966-8904

Other names 1

  • Prerana Aghamkar Former name

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
I20260207000821 NC Practitioner - Pediatric Medicine 7214416569 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Wright State University Boonshoft School of Medicine, 2014
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

100 Kimel Forest Dr
Winston Salem, NC 27103-6074

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2020-01643NCMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Dec 17, 2025 Accepting new patients

Locations

2311 Lewisville Clemmons Rd
Clemmons, NC 27012
Phone (336) 713-0400

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

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": "1395792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1114344207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KIMEL FOREST DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271573818",
            "telephone_number": "336-713-4500",
            "fax_number": "336-713-4501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2311 Lewisville Clemmons Rd",
            "address_purpose": "LOCATION",
            "city": "Clemmons",
            "state": "NC",
            "postal_code": "270128905",
            "country_code": "US",
            "telephone_number": "336-713-4500",
            "fax_number": "336-716-4501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "571 S Floyd St",
            "address_2": "Suite 412",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402023818",
            "country_code": "US",
            "telephone_number": "502-629-8828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3020 Childrens Way # Mc5030",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921234223",
            "country_code": "US",
            "telephone_number": "858-966-8904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "PRERANA",
        "middle_name": "AGHAMKAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-26",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NC",
            "license": "2020-01643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PRERANA",
            "last_name": "AGHAMKAR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.