Healthcare Provider Details

I. General information

NPI: 1992610240
Provider Name (Legal Business Name): CONNOR THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 BEN BRANTLEY RD
DUBLIN GA
31021-9697
US

IV. Provider business mailing address

769 BEN BRANTLEY RD
DUBLIN GA
31021-9697
US

V. Phone/Fax

Practice location:
  • Phone: 478-595-5199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN302923
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: