Basic Information
| Provider Information | |||||||||
| NPI: | 1609349380 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | AARON | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2090 CARETTA ST | ||||||||
| Address2: | |||||||||
| City: | NORTH AUGUSTA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298412817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122533507 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3651 WHEELER RD | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309096521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066513232 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2019 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN237295 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.