Individual
ALAN CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
115 KINGS RD, ATHENS, GA 30606-3109
(706) 202-3187
Mailing address
PO BOX 48749, ATHENS, GA 30604-8749
(706) 202-3187
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
RLQA001930
GA
Other
Enumeration date
07/24/2021
Last updated
07/24/2021
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