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General NPI Number Information
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NPI Number | 1770766909
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Entity Type | Organization
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Legal Business Name | GLENN E. FUSSELL
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 2827 WARM SPRINGS RD SUITE 3B
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City | COLUMBUS
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State | GA
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Zip | 31904-5246
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Country | US
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Telephone | 706-324-4177
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Fax | 706-322-9637
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Provider Business Mailing Address
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Address Line | 2827 WARM SPRINGS RD SUITE 3B
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City | COLUMBUS
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State | GA
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Zip | 31904-5246
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Country | US
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Telephone | 706-324-4177
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Fax | 706-322-9637
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Authorized Official
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Title or Position | OWNER
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Name | GLENN E. FUSSELL
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Credential | M.D.
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Telephone | 706-324-4177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 026777
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License Number State | GA
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