Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 6980 | GA |
NPI | 1245371426 |
---|---|
Provider Name | Dr. Joshua H Glass |
First Address | Atlanta, GA 30308-1256 |
Second Address | Atlanta, GA 30308-1256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 16/09/2010 |