Provider Demographics
NPI:1669819355
Name:BORGERDING, CONNIE J (DO)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:J
Last Name:BORGERDING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 WHITE CIR STE 105
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5836
Mailing Address - Country:US
Mailing Address - Phone:770-420-1600
Mailing Address - Fax:770-999-2802
Practice Address - Street 1:98 DOCTORS DR STE 200
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-4502
Practice Address - Country:US
Practice Address - Phone:828-588-9716
Practice Address - Fax:828-586-4083
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36080207Q00000X
NC2016-00355207Q00000X
390200000X
GA89803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC360808Medicaid
SCSC80895019Medicare PIN