Provider Demographics
NPI:1245531821
Name:CONNER, EBONY B (DPM)
Entity type:Individual
Prefix:DR
First Name:EBONY
Middle Name:B
Last Name:CONNER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:B
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:950 EAGLES LANDING PKWY # 592
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7343
Mailing Address - Country:US
Mailing Address - Phone:678-489-4210
Mailing Address - Fax:678-489-4088
Practice Address - Street 1:300 PRIME POINT, SUITE 100
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6851
Practice Address - Country:US
Practice Address - Phone:678-489-4210
Practice Address - Fax:678-489-4088
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001241213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery