MEDICARE: ANTHONY JOHN ATALA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	200400099	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1359J	OTHER	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7644683	OTHER	AETNA
6	804009	OTHER	PARTNERS
7	D2424	OTHER	MEDCOST

General Provider Information

NPI Number	:	1235111832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY JOHN ATALA MD

Provider Business Mailing Address
First Line	:	100 KIMEL FOREST DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6074
Country	:	US
Telephone Number	:	336-716-0238
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 CHARLOIS BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1522
Country	:	US
Telephone Number	:	336-716-4131
Fax Number	:	336-713-0328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	06/14/2022

Similar Medicare Providers

1568024594 — KAYLA MARGARET SNEDECOR BCBA
Practice Location Address:

130 CHARLOIS BLVD
WINSTON SALEM, NC
27103-1522

Practice Phone: 336-777-7239
Practice Fax: 317-520-8200

1669338976 — SARAH JO BARE CNM
Practice Location Address:

114 CHARLOIS BLVD
WINSTON SALEM, NC
27103-1522

Practice Phone: 336-765-5470
Practice Fax:

1477549707 — ROBERT JAMES EVANS III MD
Practice Location Address:

140 CHARLOIS BLVD
WINSTON SALEM, NC
27103-1522

Practice Phone: 336-716-2255
Practice Fax: 336-716-9042

1528054673 — RONALD LEE DAVIS III MD
Practice Location Address:

140 CHARLOIS BLVD
WINSTON SALEM, NC
27103-1522

Practice Phone: 336-716-4131
Practice Fax: 336-713-0328

1144202755 — STEVE JAMES HODGES MD
Practice Location Address:

140 CHARLOIS BLVD
WINSTON SALEM, NC
27103-1522

Practice Phone: 336-716-2255
Practice Fax: 336-716-9042

1073593943 — MR. RONALD BERNARD SHEALY MD
Practice Location Address:

110 CHARLOIS BLVD
WINSTON SALEM, NC
27103-1522

Practice Phone: 336-768-3361
Practice Fax: 336-768-4131

Directions to “ ANTHONY JOHN ATALA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.