Individual
CYMANTHIA KEESHA CONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
81 NORTHSIDE DAWSON DR STE 100A, DAWSONVILLE, GA 30534-7166
(706) 216-6000
(706) 216-6010
Mailing address
PO BOX 742495, ATLANTA, GA 30374-2495
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0440473
KS
207Q00000X
Family Medicine Physician
2013022689
MO
207Q00000X
Family Medicine Physician
Primary
68859
GA
261QP2300X
Primary Care Clinic/Center
207Q00000X
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA1870009
MEDICARE PTAN
MO
Enumeration date
07/01/2010
Last updated
02/26/2021
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