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General NPI Number Information
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NPI Number | 1356762553
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Entity Type | Organization
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Legal Business Name | EDWARD D CONNER MD PC
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 12/16/2013
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Provider Practice Location Address
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Address Line | 112 GLENEAGLES CIR
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City | MACON
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State | GA
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Zip | 31210-2943
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Country | US
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Telephone | 478-747-9474
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Fax |
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Provider Business Mailing Address
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Address Line | 112 GLENEAGLES CIR
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City | MACON
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State | GA
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Zip | 31210-2943
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Country | US
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Telephone | 478-747-9474
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD DARRELL CONNER
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Credential | MD
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Telephone | 478-747-9474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 035027
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License Number State | GA
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