Healthcare Provider Details

I. General information

NPI: 1205810215
Provider Name (Legal Business Name): TONY JAMES CONNOT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 PINEVILLE MATTHEWS RD STE D
PINEVILLE NC
28134-8826
US

IV. Provider business mailing address

4601 PARK RD STE 300
CHARLOTTE NC
28209-2290
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-3300
  • Fax:
Mailing address:
  • Phone: 704-323-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103473
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: