Leporsche Marquita Cannon

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Practice address

205 Dental Dr Ste 11
Warner Robins, GA 31088-8216

Phone

(478) 334-2091

NPI assigned

Sep 6, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1528789997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 DENTAL DR STE 11",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310888216",
            "telephone_number": "478-334-2091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 DENTAL DR STE 11",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310888216",
            "telephone_number": "478-334-2091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "LEPORSCHE",
        "middle_name": "MARQUITA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-06",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Yrevahaircare.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "205 Dental Dr Ste 11",
            "city": "Warner Robins",
            "state": "GA",
            "country_code": "US",
            "postal_code": "310888216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Warner Robins, GA
• Providers in Warner Robins, GA by specialty
• Prosthetic/Orthotic Supplier in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.