Healthcare Provider Details

I. General information

NPI: 1649252263
Provider Name (Legal Business Name): JOHN PHILIP CONNORS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MOUNT VERNON HWY SUITE 250
ATLANTA GA
30328-4274
US

IV. Provider business mailing address

755 MOUNT VERNON HWY SUITE 250
ATLANTA GA
30328-4274
US

V. Phone/Fax

Practice location:
  • Phone: 404-348-4456
  • Fax: 404-348-4495
Mailing address:
  • Phone: 404-348-4456
  • Fax: 404-348-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number060249
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: