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General NPI Number Information
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NPI Number | 1013198050
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Entity Type | Organization
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Legal Business Name | JAMES E. GLEASON JR, MDPC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 33 UPPER RIVERDALE RD SW STE 118
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City | RIVERDALE
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State | GA
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Zip | 30274-2642
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Country | US
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Telephone | 770-994-6969
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Fax | 888-651-5324
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Provider Business Mailing Address
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Address Line | PO BOX 962466
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City | RIVERDALE
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State | GA
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Zip | 30296-6923
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Country | US
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Telephone | 678-361-8091
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Fax | 888-651-5324
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Authorized Official
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Title or Position | MD
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Name | JAMES E GLEASON JR.
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Credential | MD
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Telephone | 770-994-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 030466
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License Number State | GA
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