Provider Demographics
NPI:1659347581
Name:CONLEY, NATASHIA REBECCA (MD)
Entity Type:Individual
Prefix:MRS
First Name:NATASHIA
Middle Name:REBECCA
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:NATASHIA
Other - Middle Name:REBECCA
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 GENEVIEVE CT STE A
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4868
Mailing Address - Country:US
Mailing Address - Phone:770-486-1818
Mailing Address - Fax:704-861-8187
Practice Address - Street 1:100 GENEVIEVE CT STE A
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4868
Practice Address - Country:US
Practice Address - Phone:770-486-1818
Practice Address - Fax:704-861-8187
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26091207R00000X
GA068391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00146103OtherRAILROAD MEDICARE
H77074Medicare UPIN