Healthcare Provider Details

I. General information

NPI: 1144030131
Provider Name (Legal Business Name): WILLIAM REED CONN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4546 BARCLAY DR
DUNWOODY GA
30338-7147
US

IV. Provider business mailing address

4546 BARCLAY DR
DUNWOODY GA
30338-7147
US

V. Phone/Fax

Practice location:
  • Phone: 770-457-7994
  • Fax:
Mailing address:
  • Phone: 770-457-7994
  • Fax: 770-458-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN305723
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: