Individual provider Active NPI

Cody Wayne Connell

  • Acute Care Nurse Practitioner
  • Carrollton, GA
National Provider Identifier
1770170342
Registry record updated Oct 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
APRN-NP261203 Issued in GA
Practice address
706 Dixie St Ste 320
Carrollton, GA 30117-3890
Phone
(770) 836-9326
NPI assigned
Dec 29, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2100X APRN-NP261203 GA Primary

Addresses

Primary practice location

706 Dixie St Ste 320
Carrollton, GA 30117-3890

Mailing address

292 Waters Edge Pkwy
Temple, GA 30179-5830
Phone (256) 591-6459

Other practice location 1

1365 Clifton Rd NE
Atlanta, GA 30322-3818
Phone (404) 778-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221222000377 GA Practitioner - Nurse Practitioner 5799155479 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

100 Greenway Blvd
Carrollton, GA 30117-4338

706 Dixie St
Suite 220
Carrollton, GA 30117-3819

Hospital & facility affiliations

  • Tanner Medical Center - Carrollton Hospital, Carrollton, GA, CCN 110011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN-NP261203GAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Medical Group Inc Single Specialty CurrentSince Jan 25, 2023 Accepting new patients
The Emory Clinic Inc Single Specialty CurrentSince Nov 10, 2022 Accepting new patients
Carrollton Surgical Group, P. a. Single Specialty PastSince Jan 25, 2023 Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

706 Dixie St
Ste 220
Carrollton, GA 30117
Phone (770) 812-8825

706 Dixie St
Ste 320
Carrollton, GA 30117
Phone (770) 812-9326

705 Dixie St
Carrollton, GA 30117
Phone (770) 812-9666

690 Dallas Hwy
Ste 207A
Villa Rica, GA 30180
Phone (770) 456-3646

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760054400000",
    "number": "1770170342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "292 WATERS EDGE PKWY",
            "city": "TEMPLE",
            "state": "GA",
            "postal_code": "301795830",
            "telephone_number": "256-591-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 DIXIE ST STE 320",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173890",
            "telephone_number": "770-836-9326"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1365 Clifton Rd NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303223818",
            "country_code": "US",
            "telephone_number": "404-778-4500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONNELL",
        "first_name": "CODY",
        "middle_name": "WAYNE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-29",
        "last_updated": "2025-10-10",
        "certification_date": "2025-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "APRN-NP261203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.