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General NPI Number Information
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NPI Number | 1639268956
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Entity Type | Individual
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Provider Name | ROYCE MARLIN CANNINGTON III MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 2715 MCCALL CT
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City | ALBANY
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State | GA
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Zip | 31721-9194
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Country | US
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Telephone | 352-359-2696
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Fax | 229-405-1268
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Provider Business Mailing Address
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Address Line | 2715 MCCALL CT
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City | ALBANY
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State | GA
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Zip | 31721-9194
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Country | US
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Telephone | 352-359-2696
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Fax | 229-405-1268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 060706
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License Number State | GA
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