NPIMap

Organization Active NPI

John a. Glenn Jr. Center for Community Healthcare Inc.

  • Family Medicine Physician
  • Eastman, GA
National Provider Identifier
1275736100
Registry record updated Dec 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
03995 Issued in GA
Legal business name
JOHN A. GLENN JR. CENTER FOR COMMUNITY HEALTHCARE INC.
Practice address
1112 Plaza Ave
Suite C
Eastman, GA 31023-9009
Phone
(478) 374-1308
Fax
(478) 374-0302
NPI assigned
Jun 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2008

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

Authorized official

Name
Dr. John A Glenn Jr., MD
Title
Owner
Phone
(478) 374-1308

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 03995 GA Primary

Addresses

Primary practice location

1112 Plaza Ave
Suite C
Eastman, GA 31023-9009

Mailing address

1112 Plaza Ave
Suite C
Eastman, GA 31023-9009
Phone (478) 374-1308

Other identifiers 1

IdentifierTypeStateIssuer
000613874AMedicaidGA

National Provider Directory

National Provider Directory

Locations

1112 Plaza Ave
Ste C
Eastman, GA 31023
Phone (478) 374-1308

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228435200000",
    "number": "1275736100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 PLAZA AVE",
            "address_2": "SUITE C",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310239009",
            "telephone_number": "478-374-1308",
            "fax_number": "478-374-0302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 PLAZA AVE",
            "address_2": "SUITE C",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310239009",
            "telephone_number": "478-374-1308",
            "fax_number": "478-374-0302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN A. GLENN JR. CENTER FOR COMMUNITY HEALTHCARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2008-12-05",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-374-1308",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "03995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000613874A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eastman, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2008; 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.