MEDICARE: DR. JOHN PHILIP CONNORS III MD

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	208200000X	Plastic Surgery Physician	060249	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	A38860	OTHER		MEDICARE B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	470374	OTHER	TUFTS HEALTH PLAN
3	042472266	OTHER	PRIVATE HEALTHCARE SYSTEM
4	1074088	OTHER	AETNA US HEALTHCARE
5	5645021	OTHER	FIRST HEALTH
6	92688	OTHER	FALLON COMMUNITY HEALTH
7	AA39058	OTHER	HARVARD PILGRIM HEALTHCAR
8	J29061	OTHER	BLUE CARE ELECT

General Provider Information

NPI Number	:	1649252263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PHILIP CONNORS III MD

Provider Business Mailing Address
First Line	:	755 MOUNT VERNON HWY
Second Line	:	SUITE 250
City	:	ATLANTA
State	:	GA
Zip	:	30328-4274
Country	:	US
Telephone Number	:	404-348-4456
Fax Number	:	404-348-4495

Provider Business Practice Location Address
First Line	:	755 MOUNT VERNON HWY
Second Line	:	SUITE 250
City	:	ATLANTA
State	:	GA
Zip	:	30328-4274
Country	:	US
Telephone Number	:	404-348-4456
Fax Number	:	404-348-4495

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	09/25/2020

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