Provider Demographics
NPI:1215211677
Name:GLOVER, WILLIAM G (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:GLOVER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STEAM PLANT RD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-461-7355
Mailing Address - Fax:615-461-7418
Practice Address - Street 1:300 STEAM PLANT RD.
Practice Address - Street 2:SUITE 300
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-461-7355
Practice Address - Fax:615-461-7418
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2001363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1529576Medicaid
TN103I975363Medicare PIN