Provider Demographics
NPI:1467195529
Name:GODBOLD, ANTONYA WERNER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONYA
Middle Name:WERNER
Last Name:GODBOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 ASKHAM DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4737
Mailing Address - Country:US
Mailing Address - Phone:919-460-5363
Mailing Address - Fax:
Practice Address - Street 1:1321 OBERLIN RD STE A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2052
Practice Address - Country:US
Practice Address - Phone:919-828-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900844208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics