Provider Demographics
NPI:1326350463
Name:JACOBS, GLENDA R (RN, CDE)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:R
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE
Mailing Address - Street 2:SUITE 452
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6200
Mailing Address - Country:US
Mailing Address - Phone:912-350-5909
Mailing Address - Fax:912-350-5914
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 452
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-5909
Practice Address - Fax:912-350-5914
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN029458163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA885842548AMedicaid
GAP00869908OtherRR MEDICARE
GA569140OtherWELLCARE
GA885842548AMedicaid