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NPI Code Detail

MEDICARE: CLARK H GLASS M.D.

MEDICARE: CLARK H GLASS 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
1207X00000XOrthopaedic Surgery Physician017387GA

General Provider Information

NPI Number : 1447253505
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARK H GLASS M.D.
Provider Business Mailing Address
First Line : 300 TOWER RD NE
Second Line : STE 200
City : MARIETTA
State : GA
Zip : 30060-9403
Country : US
Telephone Number : 770-427-5717
Fax Number : 770-429-6503
Provider Business Practice Location Address
First Line : 300 TOWER RD NE
Second Line : STE 200
City : MARIETTA
State : GA
Zip : 30060-9403
Country : US
Telephone Number : 770-427-5717
Fax Number : 770-429-6503
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 12/05/2013

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Directions to “ CLARK H GLASS M.D.” Practice Location

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