Individual
PHILIP JOHN CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30045-7694
(678) 442-3317
(678) 442-4416
Mailing address
1466 PEACHTREE BATTLE AVE NW, ATLANTA, GA 30327-1426
(678) 442-3317
(678) 442-4416
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
029853
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00361292E
—
GA
Enumeration date
02/27/2007
Last updated
07/08/2007
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