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General NPI Number Information
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NPI Number | 1942579727
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Entity Type | Organization
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Legal Business Name | LAURETTA A CONNELLY, MD PC
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 109 W 6TH ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-1721
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Country | US
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Telephone | 931-528-6945
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Fax | 931-372-2234
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Provider Business Mailing Address
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Address Line | 109 W 6TH ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-1721
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Country | US
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Telephone | 931-528-6945
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Fax | 931-372-2234
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Authorized Official
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Title or Position | OWNER
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Name | LAURETTA A CONNELLY
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Credential | MD
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Telephone | 931-528-6945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 29602
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License Number State | TN
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