Provider Demographics
NPI:1154503472
Name:THE UROLOGY INSTITUTE AND CONTINENCE CENTER,PC
Entity Type:Organization
Organization Name:THE UROLOGY INSTITUTE AND CONTINENCE CENTER,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:DANELL
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-227-0086
Mailing Address - Street 1:817 SMITH AVE
Mailing Address - Street 2:PO BOX 2155
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5643
Mailing Address - Country:US
Mailing Address - Phone:229-227-0086
Mailing Address - Fax:229-227-5929
Practice Address - Street 1:817 SMITH AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5643
Practice Address - Country:US
Practice Address - Phone:229-227-0086
Practice Address - Fax:229-227-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034521208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP3963Medicare PIN