MEDICARE: MICHELLE A GLASGOW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	67423	GA
2	207VX0201X	Gynecologic Oncology Physician	067423	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184882524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE A GLASGOW M.D.

Provider Business Mailing Address
First Line	:	980 JOHNSON FERRY RD
Second Line	:	STE 900
City	:	ATLANTA
State	:	GA
Zip	:	30342-4768
Country	:	US
Telephone Number	:	404-459-1900
Fax Number	:	678-354-7992

Provider Business Practice Location Address
First Line	:	460 NORTHSIDE CHEROKEE BLVD STE 400
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8023
Country	:	US
Telephone Number	:	770-721-9400
Fax Number	:	770-721-9401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2008
Last Update Date	:	03/07/2018

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Directions to “ MICHELLE A GLASGOW M.D.” Practice Location

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