Provider Demographics
NPI:1437481256
Name:BOATMAN, CONNIE REYNOLDS (MPA, PA-C)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:REYNOLDS
Last Name:BOATMAN
Suffix:
Gender:F
Credentials:MPA, PA-C
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:MARIE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPA, PA-C
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:DAVIS FISCHER BUILDING OFFICE 3245A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:DAVIS FISCHER BUILDING OFFICE 3245A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:404-686-7841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant