Provider Demographics
NPI:1215788757
Name:PRAYER, ANTOINE MARQUISE (MD)
Entity type:Individual
Prefix:
First Name:ANTOINE
Middle Name:MARQUISE
Last Name:PRAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 NORTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-2057
Mailing Address - Country:US
Mailing Address - Phone:252-864-0377
Mailing Address - Fax:
Practice Address - Street 1:1801 ROZZELLES FERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4228
Practice Address - Country:US
Practice Address - Phone:704-446-9987
Practice Address - Fax:704-384-5996
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program