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General NPI Number Information
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NPI Number | 1740641406
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Entity Type | Organization
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Legal Business Name | GLORY REALM HEALTHCARE CONSULTANTS LLC
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Dates
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Enumeration Date | 03/09/2016
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 2296 HENDERSON MILL RD NE STE 116
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City | ATLANTA
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State | GA
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Zip | 30345-2739
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Country | US
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Telephone | 404-692-6907
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Fax |
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Provider Business Mailing Address
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Address Line | 2296 HENDERSON MILL RD NE STE 116
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City | ATLANTA
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State | GA
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Zip | 30345-2739
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Country | US
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Telephone | 404-692-6907
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. CLAUDETTE ANGELLA JOHNSON
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Credential | NP-C
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Telephone | 404-692-6907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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