Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 51324 | GA |
NPI | 1063411643 |
---|---|
Provider Name | Julie Glasson |
First Address | Atlanta, GA 30342-2807 |
Second Address | Atlanta, GA 30342-2807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 25/06/2021 |