Provider Demographics
NPI:1992000483
Name:CONNER, LILANA EUGENIA (HAD)
Entity Type:Individual
Prefix:
First Name:LILANA
Middle Name:EUGENIA
Last Name:CONNER
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5987 ALLEE WAY
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517
Mailing Address - Country:US
Mailing Address - Phone:678-710-3004
Mailing Address - Fax:678-710-3054
Practice Address - Street 1:1000 HAWTHORNE AVE
Practice Address - Street 2:SUITE O
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:678-710-3004
Practice Address - Fax:678-710-3054
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000749237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist