Basic Information
| Provider Information | |||||||||
| NPI: | 1992984066 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONNER FAMILY HEALTH CLINIC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 W MATTHEWS ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281051309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047084301 | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 W MATTHEWS ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281051309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047084301 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2007 | ||||||||
| LastUpdateDate: | 08/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | CONNER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7047084301 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 9701293 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2344531 | 01 | PTAN | OTHER |