Individual
JENNIFER CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1041 KIRKPATRICK RD STE 150, BURLINGTON, NC 27215-8068
(336) 538-1888
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-2255
(336) 716-6637
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2010-01071
NC
2086S0102X
Surgical Critical Care Physician
2010-01071
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5914975
—
NC
Enumeration date
04/09/2007
Last updated
08/17/2021
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