Provider Demographics
NPI:1588942981
Name:CONLON, WILLIAM G (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:CONLON
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WARREN CARROLL DR
Mailing Address - Street 2:BOX 8502
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27695-8502
Mailing Address - Country:US
Mailing Address - Phone:919-623-8361
Mailing Address - Fax:
Practice Address - Street 1:2500 WARREN CARROLL DR
Practice Address - Street 2:BOX 8502
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-8502
Practice Address - Country:US
Practice Address - Phone:919-623-8361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer