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General NPI Number Information
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NPI Number | 1457796880
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Entity Type | Individual
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Provider Name | DAVID NORWOOD GLISSON SR. L.M.T.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 7370 HODGSON MEMORIAL DR STE A6
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City | SAVANNAH
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State | GA
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Zip | 31406-2538
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Country | US
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Telephone | 912-665-2302
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Fax | 912-920-0025
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Provider Business Mailing Address
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Address Line | PO BOX 61022
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City | SAVANNAH
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State | GA
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Zip | 31420-1022
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Country | US
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Telephone | 912-665-2302
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Fax | 912-920-0025
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT003934
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License Number State | GA
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