MEDICARE: DR. HEATHER CANNON M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	22698	MS
3	207Q00000X	Family Medicine Physician	29398	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801082409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER CANNON M.D.

Provider Business Mailing Address
First Line	:	1122 E MAIN ST
Second Line	:	SUITE 4
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-2348
Country	:	US
Telephone Number	:	601-656-1001
Fax Number	:	601-656-7555

Provider Business Practice Location Address
First Line	:	1122 E MAIN ST
Second Line	:	SUITE 4
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-2348
Country	:	US
Telephone Number	:	601-656-1001
Fax Number	:	601-656-7555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	07/21/2015

Similar Medicare Providers

1366541872 — JULIA E RILEY MD
Practice Location Address:

1122 E MAIN ST , NESHOBA PEDIATRICS SUITE 6
PHILADELPHIA, MS
39350-2348

Practice Phone: 601-656-9900
Practice Fax:

1275621211 — NESHOBA COUNTY GENERAL HOSPITAL
Practice Location Address:

1122 E MAIN ST , SUITE 4
PHILADELPHIA, MS
39350-2348

Practice Phone: 601-656-1001
Practice Fax: 601-656-7555

1942399118 — NESHOBA COUNTY GENERAL HOSPITAL
Practice Location Address:

1122 E MAIN ST STE 6
PHILADELPHIA, MS
39350-2348

Practice Phone: 601-656-9900
Practice Fax: 601-656-9933

1740479377 — DENITA KAYE THOMAS FNP
Practice Location Address:

1122 E MAIN ST STE 6
PHILADELPHIA, MS
39350-2348

Practice Phone: 601-656-9900
Practice Fax: 601-656-9933

1164727269 — TONIA HOLLEY NP
Practice Location Address:

1122 E MAIN ST , SUITE 4
PHILADELPHIA, MS
39350-2348

Practice Phone: 601-656-1001
Practice Fax: 601-656-7555

1922068634 — STEPHEN P HAUPTMAN DO
Practice Location Address:

2601 PENNSYLVANIA AVE , UNIT C6
PHILADELPHIA, PA
19130-2348

Practice Phone: 215-564-4880
Practice Fax: 215-564-4890

Directions to “ DR. HEATHER CANNON M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.