Healthcare Provider Details

I. General information

NPI: 1831553924
Provider Name (Legal Business Name): CONNOR JORDAN BISKAMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 08/07/2023
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AUGUSTA UNIVERSITY 1120 15TH STREET
AUGUSTA GA
30912-3901
US

IV. Provider business mailing address

1120 15TH ST # BB-7513
AUGUSTA GA
30912-8266
US

V. Phone/Fax

Practice location:
  • Phone: 210-567-4953
  • Fax:
Mailing address:
  • Phone: 706-721-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number85904
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: