MEDICARE: JAMES E GLEASON JR. MD

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	:	1780649368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES E GLEASON JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 962466
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-6923
Country	:	US
Telephone Number	:	770-994-6969
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	01/16/2024

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Directions to “ JAMES E GLEASON JR. MD” Practice Location

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