Provider Demographics
NPI:1205815388
Name:CONNER, ANGELA MELANIE (CNM)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MELANIE
Last Name:CONNER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:180 SEQUOIA TRCE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-6585
Mailing Address - Country:US
Mailing Address - Phone:706-865-1367
Mailing Address - Fax:
Practice Address - Street 1:3495 PIEDMONT RD NE
Practice Address - Street 2:NINE PIEDMONT CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1773
Practice Address - Country:US
Practice Address - Phone:404-364-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA128017367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00866863AMedicaid
GAP35172Medicare UPIN
GA00866863AMedicaid