Individual
EMILY ELIZABETH CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4300 W MAIN ST, STE 24, DOTHAN, AL 36305-1054
(334) 793-1534
(334) 793-6840
Mailing address
4300 W MAIN ST, STE 24, DOTHAN, AL 36305-1054
(334) 793-1534
(334) 793-6840
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD29882
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I024801
MEDICARE
AL
05
—
150133
—
AL
01
—
51136878
BCBS
AL
Enumeration date
06/19/2008
Last updated
12/23/2014
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