Healthcare Provider Details

I. General information

NPI: 1356638845
Provider Name (Legal Business Name): CHRISTINA C. GLOVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST SUITE 500
JACKSON MS
39202-2000
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 103
MEMPHIS TN
38120-9446
US

V. Phone/Fax

Practice location:
  • Phone: 601-352-2273
  • Fax: 601-714-3415
Mailing address:
  • Phone: 901-227-3255
  • Fax: 901-227-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number24320
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: