MEDICARE: J.J. CANNON M.D. P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD10330	TN

General Provider Information

NPI Number	:	1285823393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.J. CANNON M.D. P.C.

Provider Business Mailing Address
First Line	:	7615 HIGHWAY 51 S STE 106
Second Line	:
City	:	BRIGHTON
State	:	TN
Zip	:	38011-7043
Country	:	US
Telephone Number	:	901-837-7568
Fax Number	:	901-837-7532

Provider Business Practice Location Address
First Line	:	7615 HIGHWAY 51 S STE 106
Second Line	:
City	:	BRIGHTON
State	:	TN
Zip	:	38011-7043
Country	:	US
Telephone Number	:	901-837-7568
Fax Number	:	901-837-7532

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JESSE J CANNON JR.
Credential	:	M.D
Telephone Number	:	901-837-7568

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	02/05/2008

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