Provider Demographics
NPI:1740525054
Name:CONNER, AMY BECK (CPNP-PC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BECK
Last Name:CONNER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:CHRISTINE
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7745
Practice Address - Street 1:155 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:GA
Practice Address - Zip Code:30511-4000
Practice Address - Country:US
Practice Address - Phone:706-776-2368
Practice Address - Fax:706-776-2589
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN194985363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129979BMedicaid
GA003129979AMedicaid
GA003129979CMedicaid
GA003129979EMedicaid
GA003129979DMedicaid
GA003129979CMedicaid