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General NPI Number Information
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NPI Number | 1689620536
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Entity Type | Individual
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Provider Name | DENNIS LEO GLAUDE CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 380 HOSPITAL DR. SUITE 410
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City | MACON
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State | GA
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Zip | 31217-8014
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Country | US
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Telephone | 706-282-4200
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Fax | 706-886-8045
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Provider Business Mailing Address
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Address Line | P.O. BOX 2564
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City | MACON
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State | GA
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Zip | 31203
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Country | US
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Telephone | 478-746-5644
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Fax | 478-745-4849
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN078329
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License Number State | GA
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