Provider Demographics
NPI:1912994732
Name:CONLEY, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:CONLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 29TH AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1448
Mailing Address - Country:US
Mailing Address - Phone:615-327-4304
Mailing Address - Fax:615-327-7940
Practice Address - Street 1:1725 ASHLEY CIR
Practice Address - Street 2:SUITE 209A
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3337
Practice Address - Country:US
Practice Address - Phone:270-782-9994
Practice Address - Fax:270-842-5048
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28080207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY050032451OtherRAILROAD MEDICARE
050032451OtherMEDICARE RAILROAD
KY64280806Medicaid
KY050032451OtherRAILROAD MEDICARE
KY1275813Medicare ID - Type Unspecified