Cannon, D Timothy

Cannon, D Timothy is an individual health care provider with primary practice located at 971 Lakeland Dr Suite 1052, Jackson MS 39216-4643. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Cannon, D Timothy can be contacted via phone (601) 981-9503.

Contact Information

Primary practice address
971 Lakeland Dr Suite 1052 Jackson MS 39216-4643
Fax: (601) 981-7895
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 11015 Mississippi

Profile Details

NPI number 1033103122
LBN Legal business name Cannon, D Timothy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 6th, 2005
Last updated Oct 31st, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033103122 NPPES
Mississippi MEDICAID 00011216

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