Individual
MATTHEW DAVID CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
853 N CHURCH ST STE 510, SPARTANBURG, SC 29303-3077
(864) 560-6193
(864) 560-1510
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
LL1020
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010204
—
SC
01
—
SC98233365
MEDICARE PIN
SC
Enumeration date
10/17/2006
Last updated
09/11/2025
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