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General NPI Number Information
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NPI Number | 1336655976
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Entity Type | Individual
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Provider Name | CHERYL LYNN CONNELL RN, CCRN, LMT, MMT
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Gender | Female
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 3506 PROFESSIONAL CIR STE A
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City | MARTINEZ
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State | GA
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Zip | 30907-8234
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Country | US
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Telephone | 762-302-8007
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Fax |
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Provider Business Mailing Address
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Address Line | 155 MOREHEAD DR
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City | MARTINEZ
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State | GA
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Zip | 30907-1396
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Country | US
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Telephone | 706-284-9481
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN173280
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163WM1400X
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Taxonomy Name | Nurse Massage Therapist (NMT)
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License Number | MT010651
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163WP0000X
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Taxonomy Name | Pain Management Registered Nurse
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License Number | 173280
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License Number State | GA
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