Provider Demographics
NPI:1447631619
Name:CONNOR, CODY JEROME (MD)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:JEROME
Last Name:CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FOREST DR
Mailing Address - Street 2:STE 400
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4057
Mailing Address - Country:US
Mailing Address - Phone:803-779-7316
Mailing Address - Fax:803-343-2538
Practice Address - Street 1:3600 FOREST DR
Practice Address - Street 2:STE 400
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4057
Practice Address - Country:US
Practice Address - Phone:803-779-7316
Practice Address - Fax:803-343-2538
Is Sole Proprietor?:No
Enumeration Date:2015-06-14
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82206207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology