Healthcare Provider Details

I. General information

NPI: 1083774764
Provider Name (Legal Business Name): RAND A CONFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 AUGUSTA RD SUITE 1
THOMSON GA
30824-8498
US

IV. Provider business mailing address

PO BOX 932203
ATLANTA GA
31193-2203
US

V. Phone/Fax

Practice location:
  • Phone: 706-595-4674
  • Fax: 706-595-0088
Mailing address:
  • Phone: 706-256-3450
  • Fax: 706-256-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number41535
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number41535
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: