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DR. JACK RUSSELL CANNON II M.D.
NPI 1619030327
Radiology - Diagnostic Radiology in Edgefield, SC

Active since December 18, 2006
300 RIDGE MEDICAL PLAZA, EDGEFIELD, SC 29824(803) 637-1175 Get Directions Write a Review

NPPES record last updated: July 9, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Jack Russell Cannon Ii M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACK RUSSELL CANNON II M.D. (NPI 1619030327) is an individual diagnostic radiology provider in Edgefield, South Carolina, licensed in South Carolina (9533) and active in the NPI registry since December 2006.

NPPES Registry Identity

NPI1619030327
Entity TypeIndividualMale
Primary Taxonomy2085R0202X
Provider Legal NameDR. JACK RUSSELL CANNON IICredential: M.D.
Location Address300 RIDGE MEDICAL PLAZAEdgefield, SC 29824-9986
Mailing Address3510 Augustus RdAiken, SC 29801-2702 · (803) 649-7706
Phone(803) 637-1175
Sole ProprietorNo
Enumeration DateDecember 18, 2006
Last NPPES UpdateJuly 9, 2007
✔ NPI 1619030327 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0202X
License✔ Licensed in SC · 9533
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
300 RIDGE MEDICAL PLAZA, Edgefield, SC 29824
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Other Identifiers 2

Medicaid095332SC
Medicare UPIND05756SC

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EDGEFIELD COUNTY HOSPITAL
General Acute Care Hospital (Critical Access)
300 RIDGE MEDICAL PLAZA
EDGEFIELD, SC 29824
Edgefield County (803) 637-1157
EDGEFIELD COUNTY HOSPITAL
Medicare Defined Swing Bed Unit
300 RIDGE MEDICAL PLAZA
EDGEFIELD, SC 29824
Edgefield County (803) 637-1157
EDGEFIELD COUNTY HOSPITAL
General Acute Care Hospital (Critical Access)
300 RIDGE MEDICAL PLAZA
EDGEFIELD, SC 29824
Edgefield County (803) 637-1157
DR. WILLIAM C. BRUKER JR. M.D.
Radiology (Body Imaging)
300 RIDGE MEDICAL PLAZA
EDGEFIELD, SC 29824
Edgefield County (803) 637-1173

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 Jack Cannon's NPI number?

The NPI number for Jack Cannon is 1619030327. It was assigned to this individual provider in the NPPES registry on December 18, 2006.

Where is Jack Cannon located?

Jack Cannon practices at 300 Ridge Medical Plaza, Edgefield, SC 29824. The listed phone number is (803) 637-1175.

What is Jack Cannon's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

When was this NPI record last updated?

The NPPES record for Jack Cannon was last updated on July 9, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years 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.