Active NPI
Susan Strong Cannon, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Laurel, MS
National Provider Identifier
1003904012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 9090
- Practice address
- 15 Summer Trace Blvd
Laurel, MS 39440-2510 - Phone
- (601) 649-5390
- NPI assigned
- Oct 11, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 9090 | MS | Primary |
Addresses
Primary practice location
15 Summer Trace Blvd
Laurel, MS 39440-2510
Mailing address
15 Summer Trace Blvd
Laurel, MS 39440-2510
Phone (601) 649-5390
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9090 | MS | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1003904012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 SUMMER TRACE BLVD",
"city": "LAUREL",
"state": "MS",
"postal_code": "394402510",
"telephone_number": "601-649-5390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 SUMMER TRACE BLVD",
"city": "LAUREL",
"state": "MS",
"postal_code": "394402510",
"telephone_number": "601-649-5390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "SUSAN",
"middle_name": "STRONG",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-11",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MS",
"license": "9090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laurel, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.