Individual
ERIC JUSTIN CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
632 KING AVE, FLORENCE, SC 29501-4331
(843) 453-2891
(843) 662-1995
Mailing address
PO BOX 7246, FLORENCE, SC 29502-7246
(843) 453-2891
(843) 662-1995
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
343900000X
SC
347C00000X
Private Vehicle
Primary
347C00000X
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PCS/ORS 8156
ORS- OFFICE OF REGULATORY STAFF
SC
Enumeration date
11/30/2009
Last updated
11/30/2009
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