Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | POD001241 | GA |
NPI | 1245531821 |
---|---|
Provider Name | Dr. Ebony B Conner |
First Address | Stockbridge, GA 30281-7343 |
Second Address | Peachtree City, GA 30269-6851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2010 |
Last Update Date | 17/02/2020 |