Healthcare Provider Details

I. General information

NPI: 1871857482
Provider Name (Legal Business Name): RICHARD L GLOVER JR. D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 BROOKSIDE PKWY STE 201
ALPHARETTA GA
30022-4429
US

IV. Provider business mailing address

5780 PEACHTREE DUNWOODY RD STE 300
ATLANTA GA
30342-1513
US

V. Phone/Fax

Practice location:
  • Phone: 770-521-2295
  • Fax: 770-255-0333
Mailing address:
  • Phone: 404-303-8035
  • Fax: 404-303-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number82529
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: