Individual
VICTORIA ELIZABETH CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
250 PARKBROOKE PL STE 300, WOODSTOCK, GA 30189-6401
(770) 442-1911
(770) 928-2601
Mailing address
7 ACORN CT, GREENVILLE, SC 29609-3111
(864) 451-2745
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5090PA
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/04/2021
Last updated
10/24/2024
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