Healthcare Provider Details

I. General information

NPI: 1326579954
Provider Name (Legal Business Name): TIMOTHY CONNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3644 PEAVINE RD
CROSSVILLE TN
38571-7923
US

IV. Provider business mailing address

2 WILSHIRE HEIGHTS DR
CROSSVILLE TN
38558-6260
US

V. Phone/Fax

Practice location:
  • Phone: 931-709-0661
  • Fax:
Mailing address:
  • Phone: 931-644-9546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number888
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: