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General NPI Number Information
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NPI Number | 1770217903
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Entity Type | Individual
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Provider Name | MARKESIAE SYMONE GLENN NP
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Gender | Female
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 575 W PIKE ST
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7685
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Country | US
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Telephone | 770-277-0230
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Fax |
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Provider Business Mailing Address
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Address Line | 7 EXECUTIVE PARK DR NE APT 2407
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City | ATLANTA
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State | GA
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Zip | 30329-2271
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Country | US
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Telephone | 662-410-8202
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | NP000689
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 905222
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License Number State | MS
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