Provider Demographics
NPI:1326560129
Name:GLOVER, STEPHANIE TAMEIKA
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TAMEIKA
Last Name:GLOVER
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 1:517 N BEECH ST
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-1213
Mailing Address - Country:US
Mailing Address - Phone:229-848-4146
Mailing Address - Fax:
Practice Address - Street 1:517 N BEECH ST
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-1213
Practice Address - Country:US
Practice Address - Phone:229-848-4146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor