Healthcare Provider Details

I. General information

NPI: 1386567527
Provider Name (Legal Business Name): DENISE LYNNETTE GLENN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N POINT PKWY
ALPHARETTA GA
30022-2409
US

IV. Provider business mailing address

2020 POWERS FERRY RD SE UNIT 1464
ATLANTA GA
30339-5167
US

V. Phone/Fax

Practice location:
  • Phone: 678-928-6557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN302054
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: