Provider Demographics
NPI:1487684874
Name:CANNON, Z'THOMAS KIRK (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:Z'THOMAS
Middle Name:KIRK
Last Name:CANNON
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:119 MEADOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:UNICOI
Mailing Address - State:TN
Mailing Address - Zip Code:37692-6623
Mailing Address - Country:US
Mailing Address - Phone:423-743-5012
Mailing Address - Fax:
Practice Address - Street 1:SYDNEY & LAMONT ST
Practice Address - Street 2:JAMES H QUILLEN VA MEDIACL CENTER
Practice Address - City:MT. HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000734363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical