Healthcare Provider Details

I. General information

NPI: 1932268299
Provider Name (Legal Business Name): PATRICK A CONARRO MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 MOUNTAIN DR
DAHLONEGA GA
30533-1601
US

IV. Provider business mailing address

64 MOUNTAIN DR
DAHLONEGA GA
30533-1601
US

V. Phone/Fax

Practice location:
  • Phone: 706-864-6196
  • Fax: 706-867-0729
Mailing address:
  • Phone: 706-864-6196
  • Fax: 706-867-0729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number093-183
License Number StateGA

VIII. Authorized Official

Name: DR. PATRICK A. CONARRO
Title or Position: OWNER
Credential: M.D.
Phone: 706-864-6196