Glendale Healthcare, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

GLENDALE HEALTHCARE, LLC

Practice address

2503 Glendale Ave
Hattiesburg, MS 39401-1073

Phone

(601) 582-5805

NPI assigned

Aug 18, 2021

Last updated

Aug 18, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Akwasi Wayne Amponsah, DCNPI 1760157671

Title

Ceo

Phone

(314) 435-6386

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Akwasi Amponsah, D.O.

  • Independent Medical Examiner Chiropractor
  • Hattiesburg, MS
  • NPI 1760157671
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1063188167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2503 GLENDALE AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394011073",
            "telephone_number": "601-582-5805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2503 GLENDALE AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394011073",
            "telephone_number": "601-582-5805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A",
        "authorized_official_last_name": "AMPONSAH",
        "authorized_official_first_name": "AKWASI",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-435-6386",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wesley Glenn Girod, M. D.
• Anna Victoria Gladfelter, MD
• Arthur Lamar Glaze, MD
• Jonathan Glaze, MD
• Juanice Gandy Glaze
• Jerry Quinton Glider, DDS
• Porter Hudson Glover, M.D.
• Maria Godbolt
• Michael Anthony Goebel, M.D.
• Alice M Goff, LPC

• Primary Care Clinic/Center in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.