Provider Demographics
NPI:1679538375
Name:ANTLEY, RAY MILLS JR (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:MILLS
Last Name:ANTLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 E PARKER RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5107
Mailing Address - Country:US
Mailing Address - Phone:828-433-1235
Mailing Address - Fax:828-433-1992
Practice Address - Street 1:201 E PARKER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5107
Practice Address - Country:US
Practice Address - Phone:828-433-1235
Practice Address - Fax:828-433-1992
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98001782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131M6Medicaid
NC204234Medicare PIN