Provider Demographics
NPI:1215373527
Name:MCGLAUN, GWEN GENEVIEVE MARIE (LMT, CD(DONA))
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:GENEVIEVE MARIE
Last Name:MCGLAUN
Suffix:
Gender:F
Credentials:LMT, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 CHESHIRE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3915
Mailing Address - Country:US
Mailing Address - Phone:706-392-4174
Mailing Address - Fax:
Practice Address - Street 1:1329 WYNNTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2919
Practice Address - Country:US
Practice Address - Phone:706-392-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT007087225700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula