MEDICARE: HOLLI CONNER NEWTON PA

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	363A00000X	Physician Assistant	2010035678	MO
2	363A00000X	Physician Assistant	4072	GA

General Provider Information

NPI Number	:	1558432211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLI CONNER NEWTON PA

Provider Business Mailing Address
First Line	:	PO BOX 48089
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30604-8089
Country	:	US
Telephone Number	:	706-389-3727
Fax Number	:	706-389-3951

Provider Business Practice Location Address
First Line	:	3869 HIGHWAY 81
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-3918
Country	:	US
Telephone Number	:	678-635-8650
Fax Number	:

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	04/07/2023

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Directions to “ HOLLI CONNER NEWTON PA” Practice Location

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