Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JACK RUSSELL CANNON II, M.D.
ActiveDR. JACK RUSSELL CANNON II, M.D. is a Diagnostic Radiology healthcare provider located in EDGEFIELD, South Carolina. NPI 1619030327 is currently active in the NPPES registry. Verify at CMS.
Diagnostic Radiology · EDGEFIELD, SC
Registration Details
- NPI Number
- 1619030327
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Dec 18, 2006 (19.684599431581 yrs)
- Last Updated
- Jul 9, 2007
- License
-
9533 (SC)
Practice Information
- Address
-
300 RIDGE MEDICAL PLAZAEDGEFIELD, SC, 298249986Browse SC providers · Browse ZIP 29824
- Phone
- 8036371175
- Primary Specialty
-
Diagnostic Radiology
2085R0202X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.