RUBABA CANNON
NPI 1073964458
Nurse Practitioner - Psychiatric/Mental Health in Atlanta, GA
About Rubaba Cannon NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
RUBABA CANNON (NPI 1073964458) is an individual psychiatric/mental health provider in Atlanta, Georgia, licensed in Georgia (RN242262) and active in the NPI registry since June 2016. She is enrolled in Medicare PECOS and is a graduate of Other (2024).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Rubaba Cannon is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Rubaba Cannon reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Decatur, GA 30030
- Reassigned Medicare billing, Georgia enrollment
- 10 clinicians in this Medicare group
Atlanta, GA 30349
- Reassigned Medicare billing, Georgia enrollment
- 30 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30339 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Rubaba Cannon's NPI number?
The NPI number for Rubaba Cannon is 1073964458. It was assigned to this individual provider in the NPPES registry on June 27, 2016.
Where is Rubaba Cannon located?
Rubaba Cannon practices at 3621 Vinings Slope SE Unit 1332, Atlanta, GA 30339. The listed phone number is (404) 307-9691.
What is Rubaba Cannon's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Rubaba Cannon enrolled in Medicare?
Yes. Rubaba Cannon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Rubaba Cannon's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Rubaba Cannon reassigns Medicare benefits to 2 organizations: Dekalb Community Service Board (Decatur, GA) and Uhs Of Anchor L.P. (Atlanta, GA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Rubaba Cannon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Rubaba Cannon accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee and 1 other insurer list Rubaba Cannon as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Rubaba Cannon was last updated on January 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Rubaba Cannon · NPI 1073964458
Psychiatric/Mental Health physician in Atlanta, Georgia. Individual provider, active in the CMS NPPES registry since June 27, 2016.
## Identity
- **NPI:** 1073964458 (Entity type: Individual)
- **Enumerated:** June 27, 2016
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** RN242262 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 3621 VININGS SLOPE SE UNIT 1332, Atlanta, GA 30339-4168
- **Phone:** (404) 307-9691
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Dekalb Community Service Board (NPI 1073686978, Decatur, GA); Uhs Of Anchor L.P. (NPI 1023095429, Atlanta, GA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2024
## Record status
- **NPPES last updated:** January 29, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1073964458) · Data from the CMS NPPES public registry.