Healthcare Provider Details

I. General information

NPI: 1821654617
Provider Name (Legal Business Name): CONNOR JAMES BUTZ PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 AUBURN AVE NE STE 156
ATLANTA GA
30312-1976
US

IV. Provider business mailing address

659 AUBURN AVE NE STE 156
ATLANTA GA
30312-1976
US

V. Phone/Fax

Practice location:
  • Phone: 404-888-0228
  • Fax: 833-941-5100
Mailing address:
  • Phone: 404-888-0228
  • Fax: 833-941-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA031613
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number12729
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: