| Charles D Cannon Jr, MD | |
|
1203 Jefferson St, Laurel, MS 39440-4354 | |
| (601) 649-2863 | |
| (601) 649-9479 |
| Full Name | Charles D Cannon Jr |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine |
| Location | 1203 Jefferson St, Laurel, Mississippi |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841214145 | NPI | - | NPPES |
| 00014391 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 09089 (Mississippi) | Primary |
| Entity Name | South Central Regional Medical Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1700934676 PECOS PAC ID: 8325946411 Enrollment ID: O20031229000259 |
| Entity Name | South Central Clinics, Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1801226287 PECOS PAC ID: 4385876655 Enrollment ID: O20140515000834 |
| Mailing Address | Practice Location Address |
|---|---|
| Charles D Cannon Jr, MD 1203 Jefferson St, Laurel, MS 39440-4354 Ph: (601) 649-2863 | Charles D Cannon Jr, MD 1203 Jefferson St, Laurel, MS 39440-4354 Ph: (601) 649-2863 |
Bassam K Mechleb, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 404 S 13th Ave, Laurel, MS 39440 Phone: 601-425-5544 Fax: 601-425-5525 | |
John M. Wallace, M.D. Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 1203 Jefferson St, Laurel, MS 39440 Phone: 601-649-2863 Fax: 601-649-9479 | |
Dr. Hamit Kumar, M.B.B.S Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 1203 Jefferson St, Laurel, MS 39440 Phone: 601-649-2863 Fax: 601-649-2863 | |
Carolyn Cegielski, D.O. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 1203 Jefferson St, Laurel, MS 39440 Phone: 601-649-2863 Fax: 601-649-9479 | |
Willus Mark Horne, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 1203 Jefferson St, Laurel, MS 39440 Phone: 601-649-2863 Fax: 601-649-9479 | |
Joel Thomas Shores, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 1203 Jefferson St, Laurel, MS 39440 Phone: 601-649-2863 Fax: 601-649-9479 | |
Mr. Burgese Keki Turel, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 117 South 11th Avenue, Laurel, MS 39440 Phone: 601-425-3033 Fax: 601-422-0431 |