Healthcare Provider Details

I. General information

NPI: 1609073014
Provider Name (Legal Business Name): JULIET A GLOVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 HARDEN STREET EXT STE 141
COLUMBIA SC
29203-6894
US

IV. Provider business mailing address

3555 HARDEN ST EXT 15 MEDICAL PARK, SUITE 300
COLUMBIA SC
29203-6894
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-4300
  • Fax: 803-434-4351
Mailing address:
  • Phone: 803-545-5017
  • Fax: 803-255-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30875
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number30875
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: