Healthcare Provider Details

I. General information

NPI: 1982644407
Provider Name (Legal Business Name): GLENN E HARNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 MONTGOMERY HWY
HOOVER AL
35216-4906
US

IV. Provider business mailing address

2147 RIVERCHASE OFFICE RD
HOOVER AL
35244-1836
US

V. Phone/Fax

Practice location:
  • Phone: 205-979-0888
  • Fax: 205-979-4110
Mailing address:
  • Phone: 205-421-2122
  • Fax: 205-982-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number052451
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number27336
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number31023
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: