DR. OCTAVIA MANETTA CANNON (NPI# 1497734701) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497734701 |
| Entity Type | Individual |
| Full Name | DR. OCTAVIA MANETTA CANNON |
| Credential | D.O. |
| Practice Address |
3125 Springbank Ln Suite B Charlotte NC 28226-3345 |
| Practice Telephone | 7043411103 |
| Practice Fax Number | 7043413460 |
| Mailing Telephone | 7043411103 |
| Mailing Fax Number | 7043413460 |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2019-08-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 9900020 | NC | Other Service Providers |
| Y | 207V00000X | Obstetrics & Gynecology | 99-00020 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 891197H | 05 |
| Street Address |
3125 SPRINGBANK LN SUITE B |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28226-3345 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003895954 | Jay Berry Levy | Specialist | 3125 Springbank Ln, Suite E, Charlotte, NC 28226-3378 | 2006-01-10 |
| 1740714427 | Latisha Denise Williams | Health Educator | 3125 Springbank Ln, Suite E, Charlotte, NC 28226-3378 | 2017-04-19 |
| 1871713859 | Joseph A. Molitierno Jr. | Urology | 3125 Springbank Ln, Suite E, Charlotte, NC 28226-3379 | 2007-05-01 |
| 1952434672 | Carolinas Physicians Network, Inc. | Urology | 3125 Springbank Ln, Suite E, Charlotte, NC 28226-3378 | 2007-03-13 |
| 1396884219 | Keiran Walsh Llaneza | Physician Assistant | 3125 Springbank Ln, Suite E, Charlotte, NC 28226-3378 | 2007-02-06 |
| 1265533095 | Lowell Harley Gill | Orthopaedic Surgery | 3125 Springbank Ln, Charlotte, NC 28226-3378 | 2006-09-26 |
| 1629019088 | Arboretum Obstetrics & Gynecology | Specialist | 3125 Springbank Ln, Suite B, Charlotte, NC 28226-3345 | 2006-06-09 |
| 1700865011 | Sophia Lorraine Paige | Obstetrics & Gynecology | 3125 Springbank Ln, Suite B, Charlotte, NC 28226-3345 | 2006-01-13 |
| 1972582286 | Mala Adele Freeman-kwaku | Obstetrics & Gynecology | 3125 Springbank Ln, Suite B, Charlotte, NC 28226-3345 | 2006-01-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841837507 | Southeast Vulvar Clinic, Pllc | Dermatology | 6406 Carmel Road, Suite 309, Charlotte, NC 28226 | 2019-12-02 |
| 1427540012 | Kenneth William Riley Jr. | Behavioral Analyst | 10953 Park Rd., Charlotte, NC 28226 | 2018-05-31 |
| 1780103838 | Tamara Andres | Specialist/Technologist | 2518 Lawton Bluff Rd., Charlotte, NC 28226 | 2017-09-10 |
| 1083132609 | Xenon Anesthesia of North Carolina Pllc | Anesthesiology | 7006 Shannon Willow Road, Charlotte, NC 28226 | 2017-09-04 |
| 1104354117 | Lauren Nicole Brindisi | Chiropractor | 11230 Carmel Commons Blvd., Charlotte, NC 28226 | 2017-06-03 |
| 1346790821 | Carolinas Skin Center Pa | Plastic Surgery | 3315 Springbank Lane, Suite 202, Charlotte, NC 28226 | 2016-10-10 |
| 1871040469 | Julie R Jackson | Counselor | 7810 Prineville-mathews Road, Charlotte, NC 28226 | 2016-09-01 |
| 1518346105 | Christopher Abernathy | Dentist | 3111 Springbank Ln Ste A, Charlotte, NC 28226 | 2015-05-28 |
| 1285067504 | Amy N Bullock | Physical Therapist | 7207 Marcel Ln Apt 1138, Charlotte, NC 28226 | 2013-08-11 |
| 1528405297 | Elevate Counseling and Clinical Services, Pllc | Community/Behavioral Health | 107220 Carmel Commons Blvd., Ste. 320, Charlotte, NC 28226 | 2013-06-04 |
| Find all providers in zip 28226 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649899782 | Atrium Health North Market Network LLC | Obstetrics & Gynecology | 101 E Wt Harris Blvd Ste 5002, Charlotte, NC 28262-3588 | 2020-04-09 |
| 1528617362 | Arboretum Obstetrics & Gynecology | Obstetrics & Gynecology | 3125 Springbank Ln Ste B, Charlotte, NC 28226-3379 | 2019-09-04 |
| 1548624992 | Cassandra Yoder | Obstetrics & Gynecology | 1350 S. Kings Dr., Myers Park Clinic Ob/gyn, Charlotte, NC 28207 | 2016-04-12 |
| 1043690480 | Elizabeth Lindsay Montague-farwell | Obstetrics & Gynecology | 416 E 36th St Su 200, Charlotte, NC 28205 | 2015-06-01 |
| 1285048181 | Katie Mellington Vemireddy | Obstetrics & Gynecology | 8201 Healthcare Loop Ste 302, Charlotte, NC 28215-7072 | 2014-06-18 |
| 1467899948 | Chancy Lucas | Obstetrics & Gynecology | 325 Hawthorne Ln Ste 200, Charlotte, NC 28204 | 2013-05-24 |
| 1750727293 | Stephanie Barbadora-froelich | Obstetrics & Gynecology | 416 E 36th St Ste 200, Charlotte, NC 28205 | 2013-05-10 |
| 1992076509 | Novant Medical Group, Inc | Obstetrics & Gynecology | 11030 Golf Links Dr N, Suite 100, Charlotte, NC 28277-8200 | 2012-01-13 |
| 1073898805 | Novant Medical Group Inc | Obstetrics & Gynecology | 2610 West Arrowood Road, Charlotte, NC 28273-6134 | 2011-10-12 |
| 1164714788 | Patricia Jane Mattingly | Obstetrics & Gynecology | 6324 Fairview Rd Ste 390, Charlotte, NC 28210-4173 | 2011-05-16 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.