MEDICARE: ASHLEY ANTONY

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	207ND0101X	MOHS-Micrographic Surgery Physician	2024-00309	NC
2	207N00000X	Dermatology Physician	2024-00309	NC

General Provider Information

NPI Number	:	1780959759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ANTONY

Provider Business Mailing Address
First Line	:	1450 PROFESSIONAL PARK DR STE 150
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1307
Country	:	US
Telephone Number	:	336-724-2434
Fax Number	:	336-607-8061

Provider Business Practice Location Address
First Line	:	7200 CREEDMOOR RD STE 104
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1711
Country	:	US
Telephone Number	:	919-518-0999
Fax Number	:

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

Provider Enumeration Date	:	03/09/2012
Last Update Date	:	09/09/2024

Similar Medicare Providers

1104406230 — DR. MATTHEW ISAACS M.D.
Practice Location Address:

7200 CREEDMOOR RD STE 208
RALEIGH, NC
27613-1711

Practice Phone: 919-327-1650
Practice Fax:

1639829724 — PIERCE KNOX DO
Practice Location Address:

7200 CREEDMOOR RD STE 102
RALEIGH, NC
27613-1711

Practice Phone: 919-526-0015
Practice Fax:

1376931899 — NEKITA DANETTE BEACH
Practice Location Address:

7200 CREEDMOOR RD STE 200
RALEIGH, NC
27613-1711

Practice Phone: 919-912-5600
Practice Fax:

1538620422 — DR. CRISTIAN BLAKE SKINNER DO, PHD, ABPN
Practice Location Address:

7200 CREEDMOOR RD STE 200
RALEIGH, NC
27613-1711

Practice Phone: 919-912-5600
Practice Fax: 800-887-8477

1710598644 — DR. NICOLE DORA LICATO DNP, RN, FNP-BC
Practice Location Address:

7200 CREEDMOOR RD STE 208
RALEIGH, NC
27613-1711

Practice Phone: 919-701-5157
Practice Fax:

1891394714 — ARCHI MANISHBHAI PATEL PA-C
Practice Location Address:

7200 CREEDMOOR RD STE 200
RALEIGH, NC
27613-1711

Practice Phone: 919-912-5600
Practice Fax:

Directions to “ ASHLEY ANTONY ” 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.