Healthcare Provider Details

I. General information

NPI: 1003200312
Provider Name (Legal Business Name): BRITTANY CANNON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 E 3RD ST STE G15
CHATTANOOGA TN
37403-3327
US

IV. Provider business mailing address

975 E. THIRD STREET ATTN: PROVIDER ENROLLMENT
CHATTANOOGA TN
37403
US

V. Phone/Fax

Practice location:
  • Phone: 423-490-9080
  • Fax: 423-490-9076
Mailing address:
  • Phone: 423-490-9080
  • Fax: 423-490-9076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2728
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: