Provider Demographics
NPI:1467616748
Name:CONNELLY, TIMOTHY PATRICK JR (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:CONNELLY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1101 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5502
Mailing Address - Country:US
Mailing Address - Phone:912-350-7171
Mailing Address - Fax:912-350-3454
Practice Address - Street 1:1101 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-5502
Practice Address - Country:US
Practice Address - Phone:912-350-7171
Practice Address - Fax:912-350-3454
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGA1309Medicaid
GA288192878CMedicaid
GAP01059478OtherRAILROAD MEDICARE
GAP01059478OtherRAILROAD MEDICARE