Healthcare Provider Details

I. General information

NPI: 1790282218
Provider Name (Legal Business Name): MADISON DUCKWORTH CANNON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADISON DUCKWORTH CANNON MD

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N MAIN AVE
DEMOPOLIS AL
36732-2017
US

IV. Provider business mailing address

305 N MAIN AVE
DEMOPOLIS AL
36732-2017
US

V. Phone/Fax

Practice location:
  • Phone: 334-654-5080
  • Fax: 334-654-5081
Mailing address:
  • Phone: 334-654-5080
  • Fax: 334-654-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51643
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: