Provider Demographics
NPI:1528557220
Name:THE CONNER T MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:THE CONNER T MEDICAL GROUP PLLC
Other - Org Name:CONNER MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMBERLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-607-9064
Mailing Address - Street 1:104 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7395
Mailing Address - Country:US
Mailing Address - Phone:901-607-9064
Mailing Address - Fax:
Practice Address - Street 1:3393 KIRBY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4253
Practice Address - Country:US
Practice Address - Phone:901-607-9064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center