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General NPI Number Information
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NPI Number | 1083311302
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Entity Type | Organization
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Legal Business Name | GLAZE AND ALLEN VAN LIFT INC
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Dates
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Enumeration Date | 02/08/2023
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 2130 SIGMAN RD NW
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City | CONYERS
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State | GA
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Zip | 30012-3454
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Country | US
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Telephone | 770-483-0767
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Fax |
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Provider Business Mailing Address
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Address Line | 2130 SIGMAN RD NW
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City | CONYERS
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State | GA
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Zip | 30012-3454
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Country | US
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Telephone | 770-483-0767
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MR. TAYLOR HALL
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Credential |
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Telephone | 770-543-8905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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