Provider Demographics
NPI:1356215123
Name:CANNON, JOCELYN R
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:R
Last Name:CANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 MILLERTON AVE APT 2313
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5110
Mailing Address - Country:US
Mailing Address - Phone:312-661-6663
Mailing Address - Fax:
Practice Address - Street 1:2016 MILLERTON AVE APT 2313
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5110
Practice Address - Country:US
Practice Address - Phone:312-661-6663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist