MEDICARE: JAMES K CONLAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	023035	GA

General Provider Information

NPI Number	:	1477543312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES K CONLAN MD

Provider Business Mailing Address
First Line	:	PO BOX 859
Second Line	:
City	:	WAYCROSS
State	:	GA
Zip	:	31502-0859
Country	:	US
Telephone Number	:	912-287-1515
Fax Number	:	912-287-1394

Provider Business Practice Location Address
First Line	:	2415 PARKWOOD DR
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4722
Country	:	US
Telephone Number	:	912-287-1515
Fax Number	:	912-287-1394

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2005
Last Update Date	:	11/17/2007

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