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General NPI Number Information
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NPI Number | 1770170342
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Entity Type | Individual
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Provider Name | CODY WAYNE CONNELL
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Gender | Male
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Dates
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Enumeration Date | 12/29/2020
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 706 DIXIE ST STE 320
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City | CARROLLTON
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State | GA
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Zip | 30117-3890
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Country | US
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Telephone | 770-836-9326
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Fax |
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Provider Business Mailing Address
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Address Line | 292 WATERS EDGE PKWY
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City | TEMPLE
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State | GA
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Zip | 30179-5830
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Country | US
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Telephone | 256-591-6459
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN-NP261203
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License Number State | GA
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