Provider Demographics
NPI:1639268956
Name:CANNINGTON, ROYCE MARLIN III (MD)
Entity Type:Individual
Prefix:DR
First Name:ROYCE
Middle Name:MARLIN
Last Name:CANNINGTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BEAU
Other - Middle Name:
Other - Last Name:CANNINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2715 MCCALL CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9194
Mailing Address - Country:US
Mailing Address - Phone:352-359-2696
Mailing Address - Fax:229-405-1268
Practice Address - Street 1:2715 MCCALL CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-9194
Practice Address - Country:US
Practice Address - Phone:352-359-2696
Practice Address - Fax:229-405-1268
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0607062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCF620ZMedicare PIN