Provider Demographics
NPI:1902237423
Name:O'CONNOR, JOHN P
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11500 MIDDLEGROUND RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1222
Mailing Address - Country:US
Mailing Address - Phone:978-853-2398
Mailing Address - Fax:912-352-2460
Practice Address - Street 1:11500 MIDDLEGROUND RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419
Practice Address - Country:US
Practice Address - Phone:912-355-9098
Practice Address - Fax:912-352-2460
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-12-11907103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst