Healthcare Provider Details

I. General information

NPI: 1366152837
Provider Name (Legal Business Name): MALLORY O'CONNELL CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALLORY SCHRAM CPNP-PC

II. Dates (important events)

Enumeration Date: 11/25/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 ROBINSON LAKE RD
NEWNAN GA
30265-6275
US

IV. Provider business mailing address

10 CARLISLE ST
NEWNAN GA
30263-2293
US

V. Phone/Fax

Practice location:
  • Phone: 470-414-1329
  • Fax: 404-745-0162
Mailing address:
  • Phone: 540-935-7124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-NP712715
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: