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General NPI Number Information
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NPI Number | 1043192008
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Entity Type | Individual
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Provider Name | JAMES T CONNELL NP
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Gender | Male
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 9 RUSSELL DR
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City | ELLIJAY
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State | GA
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Zip | 30540-4001
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Country | US
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Telephone | 801-913-7489
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Fax |
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Provider Business Mailing Address
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Address Line | 3879 RUNNING FOX DR
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City | MARIETTA
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State | GA
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Zip | 30062-1017
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Country | US
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Telephone | 801-913-7489
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN273559
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License Number State | GA
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