John A Glenn Jr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

038495 Issued in GA

Practice address

840 Professional Center Dr
Eastman, GA 31023-6734

Phone

(478) 374-1310

Fax

(478) 374-0302

NPI assigned

Jun 7, 2006

Last updated

Sep 7, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Family Healthcare of Eastman Inc

  • Family Medicine Physician
  • Eastman, GA
  • NPI 1902009194
  NPD (past) Authorized official
• Dodge County Hospital Authority

  dba Eastman Family Practice

  • Family Medicine Physician
  • Eastman, GA
  • NPI 1255948717
  NPD (past)
• Dodge Emergency Group LLC

  • Nurse Practitioner
  • Eastman, GA
  • NPI 1164481065
  NPD (past)
• Evans Emergency Group LLC

  • Emergency Medicine Physician
  • Claxton, GA
  • NPI 1295794220
  NPD (past)
• McRae Emergency Services, LLC

  • Nurse Practitioner
  • McRae, GA
  • NPI 1467480400
  NPD (past)
• Med R US

  • Specialist
  • Hawkinsville, GA
  • NPI 1164732491
  NPD (past)

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315353600000",
    "number": "1194765420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 PROFESSIONAL CENTER DR",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236734",
            "telephone_number": "478-374-1310",
            "fax_number": "478-374-0302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 PROFESSIONAL CENTER DR",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236734",
            "telephone_number": "478-374-1310",
            "fax_number": "478-374-0302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "JOHN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2011-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "038495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000613874J",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Georgia CVS Pharmacy LLC (CVS Pharmacy #04564)
• Georgia Dental Associates, LLC
• Georgia Dental Associates, PC
• Georgia Oxygen Pharmacy
• Mark C. Gibbons, D.O.
• Global Eastman LLC (Eastman Healthcare & Rehab)
• Golden Personal Care Home, Inc.
• Steven Wade Grantham, DC
• Cristine Grauberger, PT, DPT
• Tori Brooke Grenade, MD

• Family Medicine Physician in Eastman, GA
• Providers in Eastman, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; 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.