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John Clark Cannon

Social Worker

Behavioral Health & Social Service Providers

1030 Jefferson Ave, Memphis, TN 38104-2127

PECOS Enrollment

This provider is enrolled in PECOS as JOHN CANNON.

Based on the most recent information from CMS, provider John Clark Cannon is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1568584514
Provider Type
Individual
Full Name
Cannon, John Clark
Title
Mr.
Credential
LMSW

Gender
Male
Sole Proprietor
No
Enumeration Date
4/3/2007
Last Updated
8/7/2012

Contact Information

Practice Location

1030 Jefferson Ave, Memphis, TN 38104-2127

(901) 523-8990

(901) 577-7518

Mailing Location

1030 Jefferson Ave, Memphis, TN 38104-2127

(901) 523-8990

(901) 577-7518

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License Unlisted Issuer

John Clark Cannon

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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Smith-Campbell, Rosemary

Tyler, Erica Leigh

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