Healthcare Provider Details

I. General information

NPI: 1871209502
Provider Name (Legal Business Name): MAUREEN CONNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 02/26/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 MANSELL RD STE B2
ROSWELL GA
30076-4800
US

IV. Provider business mailing address

875 MANSELL RD STE B2
ROSWELL GA
30076-4800
US

V. Phone/Fax

Practice location:
  • Phone: 678-461-6366
  • Fax:
Mailing address:
  • Phone: 678-461-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberHAP000399
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS001121
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: