Healthcare Provider Details

I. General information

NPI: 1528571163
Provider Name (Legal Business Name): CONNOR ROBERT BELL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 PLEASANT HILL RD STE 100
DULUTH GA
30096-5143
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-2564
US

V. Phone/Fax

Practice location:
  • Phone: 770-497-4228
  • Fax: 770-497-4474
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-362-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA003904
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: