Individual
ADDY ANTLEY CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
126 DILLON DRIVE, SPARTANBURG, SC 29307-1018
(864) 327-1212
(864) 327-1211
Mailing address
126 DILLON DRIVE, SPARTANBURG, SC 29307-1018
(864) 327-1212
(864) 327-1211
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
TL1562
SC
Other
Enumeration date
10/15/2010
Last updated
02/19/2014
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