Provider Demographics
NPI:1659667095
Name:GEIMER, CONNIE LEIGH (ACNP)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:LEIGH
Last Name:GEIMER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:LEIGH
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:420 E 2ND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3210
Mailing Address - Country:US
Mailing Address - Phone:706-509-3000
Mailing Address - Fax:
Practice Address - Street 1:32 ROUNDTREE DR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:AL
Practice Address - Zip Code:36272-5892
Practice Address - Country:US
Practice Address - Phone:256-447-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN178373363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003110639AMedicaid
GA202I506182Medicare PIN