Healthcare Provider Details

I. General information

NPI: 1598471633
Provider Name (Legal Business Name): CHRISTOPHER DAVID CONNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 VANGUARD RD
FORT STEWART GA
31315
US

IV. Provider business mailing address

8435 VANGUARD RD
FORT STEWART GA
31315
US

V. Phone/Fax

Practice location:
  • Phone: 720-725-0176
  • Fax:
Mailing address:
  • Phone: 720-725-0176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1213219
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: