Individual
MR. BENJAMIN CHAD CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPRS
Contact information
Practice address
2408 SUSANNAH ST, JOHNSON CITY, TN 37601-1732
(423) 434-6677
Mailing address
2424 E LAKEVIEW DR, JOHNSON CITY, TN 37601-1866
(423) 530-8309
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
L000000027637
TN
Other
Enumeration date
10/05/2021
Last updated
10/05/2021
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