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General NPI Number Information
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NPI Number | 1508470212
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Entity Type | Organization
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Legal Business Name | ANU GLO MED SPA, LLC.
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 2429 MAIN ST E STE 6
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City | SNELLVILLE
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State | GA
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Zip | 30078-3336
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Country | US
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Telephone | 404-664-2505
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Fax |
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Provider Business Mailing Address
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Address Line | 1573 STONEGATE WAY
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City | SNELLVILLE
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State | GA
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Zip | 30078-6701
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Country | US
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Telephone | 404-664-2505
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IVY CLEVELAND
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Credential | NP
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Telephone | 404-664-2505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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