Provider Demographics
NPI:1083311302
Name:GLAZE AND ALLEN VAN LIFT INC
Entity Type:Organization
Organization Name:GLAZE AND ALLEN VAN LIFT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-543-8905
Mailing Address - Street 1:2130 SIGMAN RD NW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3454
Mailing Address - Country:US
Mailing Address - Phone:770-483-0767
Mailing Address - Fax:
Practice Address - Street 1:2130 SIGMAN RD NW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3454
Practice Address - Country:US
Practice Address - Phone:770-483-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle