Provider Demographics
NPI:1043492333
Name:CONNALLY, TONJA J (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TONJA
Middle Name:J
Last Name:CONNALLY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CLIFF CT
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-4598
Mailing Address - Country:US
Mailing Address - Phone:404-754-9887
Mailing Address - Fax:
Practice Address - Street 1:4935 STEWART MILL RD
Practice Address - Street 2:STE 101
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6733
Practice Address - Country:US
Practice Address - Phone:678-838-4433
Practice Address - Fax:678-838-4093
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004420225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist