Healthcare Provider Details

I. General information

NPI: 1356220982
Provider Name (Legal Business Name): JORDAN CANNON AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 GEORGE C WILSON DR STE 3A
AUGUSTA GA
30909-5703
US

IV. Provider business mailing address

1215 GEORGE C WILSON DR STE 3A
AUGUSTA GA
30909-5703
US

V. Phone/Fax

Practice location:
  • Phone: 346-291-2206
  • Fax: 346-291-2206
Mailing address:
  • Phone: 346-291-2206
  • Fax: 346-291-2206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD004478
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number30004476
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAUD004478
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: