Healthcare Provider Details

I. General information

NPI: 1952307787
Provider Name (Legal Business Name): LINDA JEAN CANNON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 YORK AVE SW
ATLANTA GA
30310-2750
US

IV. Provider business mailing address

868 YORK AVE SW
ATLANTA GA
30310-2750
US

V. Phone/Fax

Practice location:
  • Phone: 404-756-6880
  • Fax: 404-756-6870
Mailing address:
  • Phone: 404-756-6880
  • Fax: 404-756-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number030972
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: