Basic Information
| Provider Information | |||||||||
| NPI: | 1184708539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCONNELL | ||||||||
| FirstName: | CONN | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 351 NEW SHACKLE ISLAND RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370752300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158240552 | ||||||||
| FaxNumber: | 6158244997 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 NEW SHACKLE ISLAND ROAD | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370752300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158240552 | ||||||||
| FaxNumber: | 6158249771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 09/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11980 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11980 | 01 | TN | MD LICENSE | OTHER | AM8870203 | 01 | TN | DEA LICENSE | OTHER |