Provider Demographics
NPI:1821045808
Name:CONNER, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:CONNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:350 HOSPITAL DR
Mailing Address - Street 2:NICU
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3838
Mailing Address - Country:US
Mailing Address - Phone:478-765-4132
Mailing Address - Fax:478-765-4171
Practice Address - Street 1:350 HOSPITAL DR
Practice Address - Street 2:NICU
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3838
Practice Address - Country:US
Practice Address - Phone:478-765-4132
Practice Address - Fax:478-765-4171
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA350272080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA35027OtherGA LICENSES