=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588091334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARSHA DANELL GLOVER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2013
-----------------------------------------------------
Last Update Date | 10/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 517 N. WESTOVER BLVD.
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-432-1411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 517 N. WESTOVER BLVD.
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-432-1411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 34750
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------