Healthcare Provider Details

I. General information

NPI: 1679173587
Provider Name (Legal Business Name): ANNA LANE CONNER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2174 N DRUID HILLS RD NE
ATLANTA GA
30329-3102
US

IV. Provider business mailing address

2174 N DRUID HILLS RD NE
ATLANTA GA
30329-3102
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number1-164740
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-164740
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: