Healthcare Provider Details

I. General information

NPI: 1982924502
Provider Name (Legal Business Name): KRISTY MICHELLE CONLON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTY MICHELLE WIEBKE DO

II. Dates (important events)

Enumeration Date: 06/05/2010
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11909 MCAULEY DRIVE BLDG 100 A2
SAVANNAH GA
31419
US

IV. Provider business mailing address

836 E. 65TH STREET SUITE 22
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-8331
  • Fax: 912-352-9782
Mailing address:
  • Phone: 912-819-7878
  • Fax: 912-819-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberUO2440
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number78850
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDO000449
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: