| Doctor Name: | MRS. JUDY P CANNON |
| NPI Number: | 1487772851 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, LPC, MAC, NCC |
| License Number: | 501791 |
| Business Practice Address: | 2281 S Main St Blakely, GA - 398232207 |
| Business Phone Number: | 2297238426 |
| Business Fax Number: | 2297237446 |
| Mailing Address: | 11953 Damascus Hilton Rd, BLAKELY |
| State: | GA |
| Postal Code: | 398237415 |
| Phone Number: | 2297234866 |
| Fax Number: | 2297237446 |
| NPI Enumeration Date: | 03/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 501791 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |