Healthcare Provider Details

I. General information

NPI: 1609798891
Provider Name (Legal Business Name): CANDICE GLOVER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 PEACHTREE RD NE STE 200
BROOKHAVEN GA
30319-2982
US

IV. Provider business mailing address

PO BOX 98010
ATLANTA GA
30359-1710
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-9186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03260945
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: