Healthcare Provider Details

I. General information

NPI: 1689342958
Provider Name (Legal Business Name): ANDREW GEORGE BERNARD GLASS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3715
US

IV. Provider business mailing address

743 SPRING ST
GAINESVILLE GA
30501
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-7296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0000070345
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: