Basic Information
| Provider Information | |||||||||
| NPI: | 1609068246 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | CASEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 907 18TH ST E STE 400 | ||||||||
| Address2: | |||||||||
| City: | TIFTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317943684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293533422 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 813 N IRWIN AVE | ||||||||
| Address2: | |||||||||
| City: | OCILLA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317743757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2294687323 | ||||||||
| FaxNumber: | 2294687320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2007 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 62400 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.