Provider Demographics
NPI:1942278015
Name:CONNELL, KWAME V (MD)
Entity Type:Individual
Prefix:
First Name:KWAME
Middle Name:V
Last Name:CONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5900 HILLANDALE DR STE 330
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3892
Mailing Address - Country:US
Mailing Address - Phone:770-817-0224
Mailing Address - Fax:770-817-0228
Practice Address - Street 1:5900 HILLANDALE DR STE 330
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3892
Practice Address - Country:US
Practice Address - Phone:770-817-0224
Practice Address - Fax:770-817-0228
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist