Provider Demographics
NPI:1497918288
Name:CANNON, JESSE B (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:B
Last Name:CANNON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EMORY HEALTHCARE
Mailing Address - Street 2:531 ASBURY CIRCLE -- ANNEX, SUITE N340
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-0001
Mailing Address - Country:US
Mailing Address - Phone:404-712-1577
Mailing Address - Fax:404-778-2630
Practice Address - Street 1:531 ASBURY CIRCLE, ANNEX
Practice Address - Street 2:SUITE N340
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-605-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061050207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine