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General NPI Number Information
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NPI Number | 1730393406
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Entity Type | Individual
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Provider Name | MS. GLORIA T BYRD
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 254 41ST ST BLDG 40709
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City | FORT GORDON
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State | GA
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Zip | 30905-5918
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Country | US
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Telephone | 706-787-3035
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 WINSTON DR
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City | DECATUR
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State | GA
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Zip | 30032-2365
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Country | US
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Telephone | 404-288-8745
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW000914
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License Number State | GA
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