Healthcare Provider Details

I. General information

NPI: 1053431973
Provider Name (Legal Business Name): PATRICIA J CONNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MOCKINGBIRD AVE
PARROTTSVILLE TN
37843
US

IV. Provider business mailing address

208 MEDICAL PARK BLVD
BRISTOL TN
37620-7343
US

V. Phone/Fax

Practice location:
  • Phone: 423-625-1170
  • Fax: 423-625-3618
Mailing address:
  • Phone: 423-989-4050
  • Fax: 423-990-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD41976
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: