Provider Demographics
NPI:1376729228
Name:DR. F. GEOFFERY CONNER PC
Entity Type:Organization
Organization Name:DR. F. GEOFFERY CONNER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-537-9488
Mailing Address - Street 1:1608 MEADOWS LN STE 1
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-9907
Mailing Address - Country:US
Mailing Address - Phone:912-537-9488
Mailing Address - Fax:912-537-8951
Practice Address - Street 1:1608 MEADOWS LN STE 1
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-9907
Practice Address - Country:US
Practice Address - Phone:912-537-9488
Practice Address - Fax:912-537-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000479014EMedicaid
GA000479014EMedicaid