Provider Demographics
NPI:1992387385
Name:MA, CONNIE (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7209 MEDICAL CENTER EAST-SOUTH TOWER
Mailing Address - Street 2:1215 21ST AVE. SOUTH
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-8605
Mailing Address - Country:US
Mailing Address - Phone:615-322-6180
Mailing Address - Fax:
Practice Address - Street 1:7209 MEDICAL CENTER EAST-SOUTH TOWER
Practice Address - Street 2:1215 21ST AVE. SOUTH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-8605
Practice Address - Country:US
Practice Address - Phone:615-322-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program