Provider Demographics
NPI:1336655976
Name:CONNELL, CHERYL LYNN (RN, CCRN, LMT, MMT)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNN
Last Name:CONNELL
Suffix:
Gender:F
Credentials:RN, CCRN, LMT, MMT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CCRN, LMT, MMT
Mailing Address - Street 1:155 MOREHEAD DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1396
Mailing Address - Country:US
Mailing Address - Phone:706-284-9481
Mailing Address - Fax:
Practice Address - Street 1:3506 PROFESSIONAL CIR STE A
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-8234
Practice Address - Country:US
Practice Address - Phone:762-302-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN173280163WC0200X
GAMT010651163WM1400X
GA173280163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Single Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)