Dr Jack Russell Cannon Ii, MD is a
Radiology - Diagnostic Radiology physician based in Edgefield, South Carolina. Dr Jack Russell Cannon Ii is licensed to practice in South Carolina (license number 9533) and his current practice location is 300 Ridge Medical Plaza, Edgefield, South Carolina. He can be reached at his office (for appointments etc.) via phone at
(803) 637-1175.
NPI number for Dr Jack Russell Cannon Ii is 1619030327 and his current mailing address is 3510 Augustus Rd, Aiken, South Carolina. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1619030327.
Physician's Profile
| Full Name | Dr Jack Russell Cannon Ii |
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| Gender | Male |
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| Speciality | Radiology - Diagnostic Radiology |
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| Location | 300 Ridge Medical Plaza, Edgefield, South Carolina |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1619030327
- Provider Enumeration Date: 12/18/2006
- Last Update Date: 07/09/2007
Medical Identifiers
Medical identifiers for Dr Jack Russell Cannon Ii such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1619030327 | NPI | - | NPPES |
| 095332 | Medicaid | SC | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 9533 (South Carolina) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jack Russell Cannon Ii is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Jack Russell Cannon Ii, MD
3510 Augustus Rd,
Aiken, SC 29801-2702
Ph: (803) 649-7706 | Dr Jack Russell Cannon Ii, MD
300 Ridge Medical Plaza,
Edgefield, SC 29824-9986
Ph: (803) 637-1175 |
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