Provider Demographics
NPI:1093225286
Name:GLOVER, FRANK EUGENE III
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:EUGENE
Last Name:GLOVER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4562 LACOSTA DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9433
Mailing Address - Country:US
Mailing Address - Phone:229-869-0722
Mailing Address - Fax:
Practice Address - Street 1:4562 LACOSTA DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-9433
Practice Address - Country:US
Practice Address - Phone:229-869-0722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055647299171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055647299OtherLICENSE