Provider Demographics
NPI:1871473298
Name:CANNON, REBEKAH (FNP-C)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 S WALL ST
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-2432
Mailing Address - Country:US
Mailing Address - Phone:706-383-6256
Mailing Address - Fax:706-383-6360
Practice Address - Street 1:426 S WALL ST
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2432
Practice Address - Country:US
Practice Address - Phone:706-383-6256
Practice Address - Fax:706-383-6360
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN284678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily