Provider Demographics
NPI:1477245868
Name:REDMOND, CONNOR PATRICK
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:PATRICK
Last Name:REDMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 W SUDBURY CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-2050
Mailing Address - Country:US
Mailing Address - Phone:404-663-7016
Mailing Address - Fax:
Practice Address - Street 1:5665 NEW NORTHSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4617
Practice Address - Country:US
Practice Address - Phone:770-874-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical