Provider Demographics
NPI:1285823393
Name:J.J. CANNON M.D. P.C.
Entity Type:Organization
Organization Name:J.J. CANNON M.D. P.C.
Other - Org Name:DR. JESSE CANNON JR.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:901-837-7568
Mailing Address - Street 1:7615 HIGHWAY 51 S STE 106
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:TN
Mailing Address - Zip Code:38011-7043
Mailing Address - Country:US
Mailing Address - Phone:901-837-7568
Mailing Address - Fax:901-837-7532
Practice Address - Street 1:7615 HIGHWAY 51 S STE 106
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:TN
Practice Address - Zip Code:38011-7043
Practice Address - Country:US
Practice Address - Phone:901-837-7568
Practice Address - Fax:901-837-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD10330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND32062Medicare PIN
TN31709102Medicare PIN