Provider Demographics
NPI:1225867369
Name:LOGAN, CONNOR (MD)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:LOGAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MADISON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-2251
Mailing Address - Country:US
Mailing Address - Phone:901-448-2884
Mailing Address - Fax:901-448-1684
Practice Address - Street 1:920 MADISON AVE SUITE 447
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-2251
Practice Address - Country:US
Practice Address - Phone:901-448-2884
Practice Address - Fax:901-448-1684
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program