Healthcare Provider Details

I. General information

NPI: 1912264466
Provider Name (Legal Business Name): TONYA GEORGE CORNWELL RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CHIPWOOD LN
ROCK HILL SC
29730-7135
US

IV. Provider business mailing address

2893 STURGIS RD
ROCK HILL SC
29730-6607
US

V. Phone/Fax

Practice location:
  • Phone: 803-327-0049
  • Fax:
Mailing address:
  • Phone: 803-366-9098
  • Fax: 803-366-9134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number71577
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: