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General NPI Number Information
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NPI Number | 1881212710
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Entity Type | Organization
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Legal Business Name | CONNELL AND KIM, O.D. ASSOCIATES LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 29 DAWSON VILLAGE WAY S
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City | DAWSONVILLE
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State | GA
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Zip | 30534-5632
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Country | US
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Telephone | 706-216-7732
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Fax | 706-216-0168
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Provider Business Mailing Address
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Address Line | 29 DAWSON VILLAGE WAY S
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City | DAWSONVILLE
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State | GA
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Zip | 30534-5632
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Country | US
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Telephone | 706-216-7732
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Fax | 706-216-0168
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Authorized Official
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Title or Position | MEMBER
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Name | MICHAEL CONNELL
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Credential | OD
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Telephone | 423-748-6778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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