Basic Information
| Provider Information | |||||||||
| NPI: | 1316919897 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANNON | ||||||||
| FirstName: | MARJORY | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 SAWTOOTH DR | ||||||||
| Address2: | APARTMENT 18 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283147902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109076589 | ||||||||
| FaxNumber: | 9109078306 | ||||||||
| Practice Location | |||||||||
| Address1: | 2817 REILLY RD | ||||||||
| Address2: | WOMACK ARMY MEDICAL CENTER | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283107324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109076589 | ||||||||
| FaxNumber: | 9109078306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.