Healthcare Provider Details

I. General information

NPI: 1124947130
Provider Name (Legal Business Name): MELISSA ANN GLOVER AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 E EVANS ST
BAINBRIDGE GA
39819-4363
US

IV. Provider business mailing address

223 TURTLE POND RD
BAINBRIDGE GA
39819-7882
US

V. Phone/Fax

Practice location:
  • Phone: 229-243-4230
  • Fax: 229-243-3390
Mailing address:
  • Phone: 229-400-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP187179
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: