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General NPI Number Information
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NPI Number | 1518278829
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Entity Type | Individual
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Provider Name | CYMANTHIA KEESHA CONNELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 81 NORTHSIDE DAWSON DR STE 100A
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City | DAWSONVILLE
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State | GA
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Zip | 30534-7166
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Country | US
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Telephone | 706-216-6000
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Fax | 706-216-6010
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Provider Business Mailing Address
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Address Line | PO BOX 742495
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City | ATLANTA
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State | GA
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Zip | 30374-2495
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 68859
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0440473
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 207Q00000X
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2013022689
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License Number State | MO
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