Provider Demographics
NPI:1942499918
Name:CONNER, BENJAMIN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DAVID
Last Name:CONNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4345 ATLANTA HWY
Mailing Address - Street 2:BUS 6
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141
Mailing Address - Country:US
Mailing Address - Phone:770-505-2880
Mailing Address - Fax:770-505-2889
Practice Address - Street 1:4345 ATLANTA HWY
Practice Address - Street 2:BUS 6
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141
Practice Address - Country:US
Practice Address - Phone:770-505-2880
Practice Address - Fax:770-505-2889
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I351697OtherMEDICARE PTAN