Healthcare Provider Details

I. General information

NPI: 1093219792
Provider Name (Legal Business Name): MR. CARL CANNADY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 AUSTIN PEAY HWY
MEMPHIS TN
38128-3802
US

IV. Provider business mailing address

3320 AUSTIN PEAY HWY
MEMPHIS TN
38128-3802
US

V. Phone/Fax

Practice location:
  • Phone: 901-343-5721
  • Fax: 855-595-7195
Mailing address:
  • Phone: 901-644-7549
  • Fax: 855-595-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: