Provider Demographics
NPI:1154459972
Name:GLENN, EMILY ELLIOTT
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELLIOTT
Last Name:GLENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 MCDONOUGH CIR
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-9798
Mailing Address - Country:US
Mailing Address - Phone:615-790-9877
Mailing Address - Fax:
Practice Address - Street 1:321 WEST 7TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38402
Practice Address - Country:US
Practice Address - Phone:931-490-1417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator