Healthcare Provider Details

I. General information

NPI: 1477245868
Provider Name (Legal Business Name): CONNOR PATRICK REDMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 W MEEKER BLVD
SUN CITY WEST AZ
85375-5282
US

IV. Provider business mailing address

4510 W SUDBURY CT
ATLANTA GA
30360-2050
US

V. Phone/Fax

Practice location:
  • Phone: 623-214-4000
  • Fax:
Mailing address:
  • Phone: 404-663-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10885
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: