Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 28873 | MS |
Y | 207VX0000X | Obstetrician | 85181 | GA |
NPI | 1275995029 |
---|---|
Provider Name | Dr. Amber L. Glenn |
First Address | Smyrna, GA 30080-8500 |
Second Address | Jasper, GA 30143-4894 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 15/10/2021 |