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NPI Code Detail

MEDICARE: ROBERT H. CONNELL, PH.D.

MEDICARE: ROBERT H. CONNELL, PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPSY000645GA

General Provider Information

NPI Number : 1518252956
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT H. CONNELL, PH.D.
Provider Business Mailing Address
First Line : 2278 MOODY RD STE D
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-1933
Country : US
Telephone Number : 478-929-0294
Fax Number : 478-923-9770
Provider Business Practice Location Address
First Line : 2278 MOODY RD STE D
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-1933
Country : US
Telephone Number : 478-929-0294
Fax Number : 478-923-9770
Authorized Official
Title or Position : OWNER
Name : ROBERT H CONNELL
Credential : PH.D.
Telephone Number : 478-929-0294
Provider Enumeration Date : 06/14/2011
Last Update Date : 06/14/2011

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