Healthcare Provider Details

I. General information

NPI: 1760314223
Provider Name (Legal Business Name): DUANESSA CANNADY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FRIST CT
COLUMBUS GA
31909-3578
US

IV. Provider business mailing address

4215 RIDGEFIELD CT
COLUMBUS GA
31907-6278
US

V. Phone/Fax

Practice location:
  • Phone: 706-494-2100
  • Fax:
Mailing address:
  • Phone: 706-615-5163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DUANESSA CARLITA CANNADY
Title or Position: CERTIFIED SURGICAL FIRST ASSITANT
Credential:
Phone: 706-615-5163