MEDICARE: JAMES E. GLEASON JR, MDPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	030466	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013198050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES E. GLEASON JR, MDPC

Provider Business Mailing Address
First Line	:	PO BOX 962466
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-6923
Country	:	US
Telephone Number	:	678-361-8091
Fax Number	:	888-651-5324

Provider Business Practice Location Address
First Line	:	33 UPPER RIVERDALE RD SW STE 118
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2642
Country	:	US
Telephone Number	:	770-994-6969
Fax Number	:	888-651-5324

Authorized Official
Title or Position	:	MD
Name	:	JAMES E GLEASON JR.
Credential	:	MD
Telephone Number	:	770-994-6969

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	01/17/2024

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