Provider Demographics
NPI:1932268299
Name:PATRICK A CONARRO MD
Entity type:Organization
Organization Name:PATRICK A CONARRO MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONARRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-864-6196
Mailing Address - Street 1:64 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1601
Mailing Address - Country:US
Mailing Address - Phone:706-864-6196
Mailing Address - Fax:706-867-0729
Practice Address - Street 1:64 MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1601
Practice Address - Country:US
Practice Address - Phone:706-864-6196
Practice Address - Fax:706-867-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA093-183261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00430834AMedicaid
GA51004953002OtherBCBS I.D. FOR ASC
GA51004953002OtherBCBS I.D. FOR ASC
GA51004953002OtherBCBS I.D. FOR ASC