ADDY ANTLEY CANNON (NPI# 1386954097) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1386954097 |
Entity Type | Individual |
Full Name | ADDY ANTLEY CANNON |
Other Name | ADDY ANTLEY SMOKE |
Credential | PA-C |
Practice Address |
126 Dillon Drive Spartanburg SC 29307-1018 |
Practice Telephone | 8643271212 |
Practice Fax Number | 8643271211 |
Mailing Telephone | 8643271212 |
Mailing Fax Number | 8643271211 |
Enumeration Date | 2010-10-15 |
Last Update Date | 2014-02-19 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
TL1562 | SC | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
126 DILLON DRIVE |
City | SPARTANBURG |
State | SC |
Zip Code | 29307-1018 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1528025137 | Foothills Nephrology PC | Internal Medicine | 126 Dillon Drive, Spartanburg, SC 29307-1018 | 2006-04-27 |
1427036144 | David Ellsworth Mullins | Internal Medicine | 126 Dillon Drive, Foothills Nephrology PC, Spartanburg, SC 29307-1018 | 2006-01-03 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023677945 | Healogics Specialty Physicians of South Carolina, LLC | Clinic/Center | 1630 Skylyn Drive, Suite 420, Spartanburg, SC 29307 | 2019-06-13 |
1194247528 | Tawnia Lee Prince | Occupational Therapy Assistant | 110 Summit Knoll Drive, Spartanburg, SC 29307 | 2017-07-07 |
1730633553 | Laura K Taylor | Chiropractor | 1802 Drayton Road, Suite 309, Spartanburg, SC 29307 | 2016-08-10 |
1013372390 | Erin Lavette Farr | Nurse Practitioner | 2780 East Main Street, Ltc Health Solutions, Spartanburg, SC 29307 | 2015-12-30 |
1316312010 | Joy Rogers | Speech-Language Pathologist | 175 Burdette St, Spartanburg, SC 29307 | 2015-12-07 |
1376923169 | Olivia Conrad | Speech-Language Pathologist | 220 Sloans Grove Rd, Spartanburg, SC 29307 | 2015-06-05 |
1457755118 | Optimal Radiology Partners of Virginia, Pllc | Radiology | 75 Skylyn Drive, Spartanburg, SC 29307 | 2014-10-09 |
1295033272 | Sean Quinn | Pharmacist | 790 East Main Street, Spartanburg, SC 29307 | 2011-03-01 |
1417250887 | James Edward Bradof | Internal Medicine | 212 Cypress Creek Drive, Spartanburg, SC 29307 | 2010-12-07 |
1528388030 | Tanya Tocharoen Tang | Internal Medicine | 126 Dillon Dr., Spartanburg, SC 29307 | 2010-06-07 |
Find all providers in zip 29307 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1790329324 | Alex Holsonback | Physician Assistant | 101 E Wood St, Spartanburg, SC 29303-3040 | 2019-11-06 |
1477905354 | Joshua Goedel | Physician Assistant | 101 E Wood St, Spartanburg, SC 29303-3040 | 2016-07-05 |
1356653968 | Kristen Bieri Koch | Physician Assistant | 126 Dillon Dr, Spartanburg, SC 29307-1018 | 2010-07-12 |
1902088867 | Amanda Falls Broome | Physician Assistant | 958 E Main St, Spartanburg, SC 29302-2148 | 2007-12-03 |
1396933461 | Kelly Martin Wilson | Physician Assistant | 1330 Boiling Springs Rd, Suite 1600, Spartanburg, SC 29303-4201 | 2007-10-13 |
1003847286 | Toni Hicks Bowyer | Physician Assistant | 98 Willow Ln, Spartanburg, SC 29307-1357 | 2006-07-05 |
1780646000 | Bonnie Brown West | Physician Assistant | 101 E Wood St, Spartanburg, SC 29303-3040 | 2006-04-03 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639712482 | Brianna Julia Starr | Physician Assistant | 1403 E Greenville St Ste B, Anderson, SC 29621-2285 | 2019-10-24 |
1255974655 | Kaitlyn T Brown | Physician Assistant | 808 Farrar Drive, Conway, SC 29526-8747 | 2019-10-18 |
1053960914 | Chad Waddell | Physician Assistant | 107 Walnut Ln, North Augusta, SC 29860-8629 | 2019-09-04 |
1508429317 | Charlotte H. Hanna | Physician Assistant | 800 E Cheves St Ste 380, Florence, SC 29506-2649 | 2019-04-17 |
1407342116 | Thrive Essential Wellness, Inc. | Physician Assistant | 1511 9th Ave Ste A, Conway, SC 29526-4126 | 2018-07-05 |
1700392495 | Stephanie Meyer | Physician Assistant | 5 Medical Park Road Palmetto Health, Columbia, SC 29203 | 2017-12-18 |
1073022612 | Gina Marie Sanitato | Physician Assistant | 1300 Hospital Dr Ste 300, Mt Pleasant, SC 29464-3217 | 2017-09-27 |
1659896264 | Morgan N Warthan | Physician Assistant | Gateway Family Medicine, 406 N Poinsett Hwy, Travelers Rest, SC 29690-1667 | 2017-08-04 |
1366994824 | Colonial Family Practice, LLC | Physician Assistant | 3750 Savannah Hwy Ste I, Johns Island, SC 29455-7909 | 2016-11-01 |
1457804080 | Mcleod Physician Associates II | Physician Assistant | 945 82nd Pkwy Ste 3, Myrtle Beach, SC 29572-4612 | 2016-08-01 |
Find all providers with the same taxonomy |
City | SPARTANBURG |
Zip Code | 29307 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.