Individual
ANTHONY JOHN ATALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
140 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 716-4131
(336) 713-0328
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-0238
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
200400099
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10078199
—
VA
01
—
1359J
BCBS
—
05
—
1810835000
—
WV
01
—
7644683
AETNA
—
01
—
804009
PARTNERS
—
05
—
891359J
—
NC
01
—
D2424
MEDCOST
—
Enumeration date
11/18/2005
Last updated
06/14/2022
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