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NPI Code Detail

MEDICARE: LINDA JEAN CANNON MD

MEDICARE: LINDA JEAN CANNON MD
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
1208000000XPediatrics Physician030972GA

Other Identifiers

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

General Provider Information

NPI Number : 1952307787
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA JEAN CANNON MD
Provider Business Mailing Address
First Line : 868 YORK AVE SW
Second Line :
City : ATLANTA
State : GA
Zip : 30310-2750
Country : US
Telephone Number : 404-756-6880
Fax Number : 404-756-6870
Provider Business Practice Location Address
First Line : 868 YORK AVE SW
Second Line :
City : ATLANTA
State : GA
Zip : 30310-2750
Country : US
Telephone Number : 404-756-6880
Fax Number : 404-756-6870
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 01/24/2013

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Directions to “ LINDA JEAN CANNON MD” Practice Location

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