Individual
CHARLES D CANNON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1203 JEFFERSON ST, LAUREL, MS 39440-4354
(601) 649-2863
(601) 649-9479
Mailing address
1203 JEFFERSON ST, LAUREL, MS 39440-4354
(601) 649-2863
(601) 649-9479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
09089
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00014391
—
MS
Enumeration date
07/27/2006
Last updated
07/11/2013
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