| Cannon Family Practice - Eastside | |
|
111 W. Roper Rd. Easley SC 29640 | |
| (864) 897-8280 | |
| (864) 897-8281 |
| Full Name | Cannon Family Practice - Eastside |
|---|---|
| Speciality | Family Medicine |
| Location | 111 W. Roper Rd., Easley, South Carolina |
| Authorized Official Name and Position | Norman Gene Rentz (CEO) |
| Authorized Official Contact | 8648784791 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cannon Family Practice - Eastside Po Box 919 Pickens SC 29671-0919 Ph: (864) 897-8286 | Cannon Family Practice - Eastside 111 W. Roper Rd. Easley SC 29640 Ph: (864) 897-8280 |
| NPI Number | 1760685143 |
|---|---|
| Provider Enumeration Date | 06/06/2007 |
| Last Update Date | 07/20/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760685143 | NPI | - | NPPES |
| GP4650 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
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