Glam Queen, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GLAM QUEEN, LLC

Practice address

13 Peach St
Butler, GA 31006-5338

Phone

(478) 391-3220

NPI assigned

Feb 22, 2023

Organization subpart

No

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

Authorized official

Name

Lena Agnes Shields

Title

Owner

Phone

(478) 391-3220

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1677024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677024000000",
    "number": "1134827769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 PEACH ST",
            "city": "BUTLER",
            "state": "GA",
            "postal_code": "310065338",
            "telephone_number": "478-391-3220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 PEACH ST",
            "city": "BUTLER",
            "state": "GA",
            "postal_code": "310065338",
            "telephone_number": "478-391-3220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLAM QUEEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-22",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A",
        "authorized_official_last_name": "SHIELDS",
        "authorized_official_first_name": "LENA",
        "authorized_official_middle_name": "AGNES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-391-3220"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Primary Care of Georgia LLC
• Decker Family Practice
• Drexel Distribution Inc
• Ieisha Freeman, LBA
• Freemans Early Intervention Services
• Glenda Louise Latimore, PH.D.
• Macon County Medical Center, Inc
• New Horizons Management, Inc
• New Horizons Management, Inc
• Scott Albert Niette, D.M.D.

• All providers in Butler, GA
• Clinical Medical Laboratory in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; 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.