Provider Demographics
NPI:1508917360
Name:CONNER, CHUCK (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:CHUCK
Middle Name:
Last Name:CONNER
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 FINDLEY CHASE
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6528
Mailing Address - Country:US
Mailing Address - Phone:229-244-9386
Mailing Address - Fax:
Practice Address - Street 1:1500 N PATTERSON ST
Practice Address - Street 2:VALDOSTA STATE UNIVERSITY, DEPT. KSPE
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31698-0100
Practice Address - Country:US
Practice Address - Phone:229-333-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0005062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer