MEDICARE: CLIFTON L CANNON III 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
1	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	059051	GA
2	208600000X	Surgery Physician	059051	GA

General Provider Information

NPI Number	:	1972780526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFTON L CANNON III MD

Provider Business Mailing Address
First Line	:	5 WAITE DR
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31406-5230
Country	:	US
Telephone Number	:	912-547-0143
Fax Number	:

Provider Business Practice Location Address
First Line	:	13055 SW 42ND ST STE 101
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3409
Country	:	US
Telephone Number	:	305-600-1738
Fax Number	:

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

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	06/17/2020

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Directions to “ CLIFTON L CANNON III MD” Practice Location

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