Active NPI
Jada Michelle Glenn, DO
- Pediatrics Physician
- Macon, GA
National Provider Identifier
1457292708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 113637
- Practice address
- 777 Hemlock St
Macon, GA 31201-2102 - Phone
- (478) 633-5437
- NPI assigned
- Apr 2, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 113637 | GA | Primary |
Addresses
Primary practice location
777 Hemlock St
Macon, GA 31201-2102
Mailing address
777 Hemlock St
Macon, GA 31201-2102
Phone (904) 252-6814
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260622003786 | GA | Order and Referring Only - Pediatric Medicine | 3577036532 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1775088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781049600000",
"number": "1457292708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "777 HEMLOCK ST",
"city": "MACON",
"state": "GA",
"postal_code": "312012102",
"telephone_number": "904-252-6814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 HEMLOCK ST",
"city": "MACON",
"state": "GA",
"postal_code": "312012102",
"telephone_number": "478-633-5437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENN",
"first_name": "JADA",
"middle_name": "MICHELLE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-04-02",
"last_updated": "2026-06-10",
"certification_date": "2026-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "113637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.