MEDICARE: DR. JAMES L. CANNON DDS,MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6721	GA

General Provider Information

NPI Number	:	1255466702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES L. CANNON DDS,MS

Provider Business Mailing Address
First Line	:	5297 CLEVELAND HWY
Second Line	:
City	:	CLERMONT
State	:	GA
Zip	:	30527-2205
Country	:	US
Telephone Number	:	770-983-7633
Fax Number	:	770-983-7884

Provider Business Practice Location Address
First Line	:	5297 CLEVELAND HWY
Second Line	:
City	:	CLERMONT
State	:	GA
Zip	:	30527-2205
Country	:	US
Telephone Number	:	770-983-7633
Fax Number	:	770-983-7884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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