MEDICARE: DANNIE W GLOVER

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	261QP2300X	Primary Care Clinic/Center

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	:	1477068849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANNIE W GLOVER

Provider Business Mailing Address
First Line	:	1550 SPARTA ST STE 7
Second Line	:
City	:	MCMINNVILLE
State	:	TN
Zip	:	37110-1315
Country	:	US
Telephone Number	:	931-474-8005
Fax Number	:	931-474-8007

Provider Business Practice Location Address
First Line	:	1550 SPARTA ST STE 7
Second Line	:
City	:	MCMINNVILLE
State	:	TN
Zip	:	37110-1315
Country	:	US
Telephone Number	:	931-474-8005
Fax Number	:	931-474-8007

Authorized Official
Title or Position	:	OWNER
Name	:	DANNIE W GLOVER
Credential	:	MD
Telephone Number	:	931-474-8005

Provider Enumeration Date	:	12/07/2017
Last Update Date	:	12/07/2017

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Directions to “DANNIE W GLOVER ” Practice Location

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