| Cannon Family Practice - Liberty | |
|
105 Liberty Blvd Liberty SC 29657-1641 | |
| (864) 843-9213 | |
| (864) 843-5634 |
| Full Name | Cannon Family Practice - Liberty |
|---|---|
| Speciality | Family Medicine |
| Location | 105 Liberty Blvd, Liberty, South Carolina |
| Authorized Official Name and Position | Michael Cunningham (CEO) |
| Authorized Official Contact | 8648981133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cannon Family Practice - Liberty Po Box 100174 Columbia SC 29202-3174 Ph: (864) 897-8280 | Cannon Family Practice - Liberty 105 Liberty Blvd Liberty SC 29657-1641 Ph: (864) 843-9213 |
| NPI Number | 1750304135 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 04/03/2023 |
| Medicare PECOS PAC ID | 8123930666 |
|---|---|
| Medicare Enrollment ID | O20031103000506 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750304135 | NPI | - | NPPES |
| GP2510 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lisa G Bryant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679661748 PECOS PAC ID: 8527075118 Enrollment ID: I20060307000244 |
| Provider Name | Trang D Lusk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437345675 PECOS PAC ID: 6406943661 Enrollment ID: I20071105000249 |
| Provider Name | Travis W Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669590477 PECOS PAC ID: 9739253642 Enrollment ID: I20080811000175 |
| Provider Name | Augusta B Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265864235 PECOS PAC ID: 6204064678 Enrollment ID: I20140109000931 |
| Provider Name | John Robert Randolph |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689677882 PECOS PAC ID: 2062557622 Enrollment ID: I20141226000079 |
| Provider Name | Joshua T Stone |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700290814 PECOS PAC ID: 1153609151 Enrollment ID: I20170619001569 |
| Provider Name | Heather Renee Turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558843664 PECOS PAC ID: 7810233376 Enrollment ID: I20190104001225 |
| Provider Name | Joshua Michael Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558851485 PECOS PAC ID: 3779965025 Enrollment ID: I20220802003878 |
Liberty Family Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 W Front St, Liberty, SC 29657 Phone: 864-843-5605 Fax: 864-843-0996 | |
Liberty Family Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 W. Front St, Liberty, SC 29657 Phone: 864-843-5605 Fax: 864-843-0096 | |
Liberty Family Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 W Front St, Liberty, SC 29657 Phone: 864-442-7557 Fax: 864-442-7579 | |
Anmed Primary Care - Liberty Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 105 Liberty Blvd, Liberty, SC 29657 Phone: 864-843-9213 Fax: 864-843-5634 |