Individual
DR. JIMMIE DALE CANNON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
220 J.L. WHITE DRIVE, SUITE 100, JASPER, GA 30143-4894
(706) 253-8001
(706) 253-8002
Mailing address
275 COLLIER ROAD, NW, SUITE 500, ATLANTA, GA 30309-1711
(404) 605-2800
(404) 351-5983
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
072875
GA
207RC0000X
Cardiovascular Disease Physician
14897
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060021300
PTAN
SC
05
—
148977
—
SC
Enumeration date
02/09/2006
Last updated
10/01/2014
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