Provider Demographics
NPI:1093219792
Name:CANNADY, CARL JR
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:CANNADY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 AUSTIN PEAY HWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-3802
Mailing Address - Country:US
Mailing Address - Phone:901-644-7549
Mailing Address - Fax:855-595-7195
Practice Address - Street 1:3320 AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3802
Practice Address - Country:US
Practice Address - Phone:901-343-5721
Practice Address - Fax:855-595-7195
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN$$$$$$$$$OtherTRANSPORTATION