Individual
MICHAEL L CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5206 WALNUT CT, LITHONIA, GA 30038-4873
(678) 481-7808
Mailing address
5206 WALNUT CT, LITHONIA, GA 30038-4873
(678) 481-7808
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0578
GA
Other
Enumeration date
03/21/2019
Last updated
03/21/2019
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