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General NPI Number Information
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NPI Number | 1376083956
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Entity Type | Individual
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Provider Name | DERICK MCCONNELL FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 723 WASHINGTON ST NW
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City | GAINESVILLE
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State | GA
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Zip | 30501
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Country | US
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Telephone | 770-531-0998
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Fax | 678-433-2059
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Provider Business Mailing Address
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Address Line | 723 WASHINGTON STREET NW SUITE 2
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City | GAINESVILLE
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State | GA
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Zip | 30501
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Country | US
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Telephone | 770-531-0998
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Fax | 678-433-2059
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN234155
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License Number State | GA
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