Healthcare Provider Details

I. General information

NPI: 1407711732
Provider Name (Legal Business Name): RAELEIGH SWINDELL CONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 SOUTH ZETTEROWER AVENUE
STATESBORO GA
30458
US

IV. Provider business mailing address

122 SOUTH ZETTEROWER AVENUE
STATESBORO GA
30458
US

V. Phone/Fax

Practice location:
  • Phone: 912-259-9991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN297011
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: