Provider Demographics
NPI:1114907565
Name:CONNOR, MICHAEL PERRY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PERRY
Last Name:CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-297-2200
Practice Address - Fax:770-534-8139
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031581207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0700328OtherUNITED HEALTHCARE
GA4107956OtherAETNA
GA000402795IMedicaid
GA341053OtherWELLCARE
GA000402795BMedicaid
GA000402795FMedicaid
GA52261652OtherBCBS
GA7762968OtherCIGNA
GA000402795GMedicaid
GA10045121OtherAMERIGROUP
GA341053OtherWELLCARE
GA000402795GMedicaid