Provider Demographics
NPI:1750432993
Name:JOHN A. CONNELL, MD, PC
Entity type:Organization
Organization Name:JOHN A. CONNELL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-534-2767
Mailing Address - Street 1:451 EE BUTLER PKWY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-4524
Mailing Address - Country:US
Mailing Address - Phone:770-534-2767
Mailing Address - Fax:770-534-6357
Practice Address - Street 1:451 EE BUTLER PKWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-4524
Practice Address - Country:US
Practice Address - Phone:770-534-2767
Practice Address - Fax:770-534-6357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033299 & 0562992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7438Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER