Provider Demographics
NPI:1376811059
Name:CLEAR GLASS, LLC
Entity Type:Organization
Organization Name:CLEAR GLASS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCE PRACTICE NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:615-596-7654
Mailing Address - Street 1:121 TYNE BAY DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4034
Mailing Address - Country:US
Mailing Address - Phone:615-596-7654
Mailing Address - Fax:
Practice Address - Street 1:510 HOSPITAL DR
Practice Address - Street 2:SUITE 304
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5033
Practice Address - Country:US
Practice Address - Phone:615-596-7654
Practice Address - Fax:615-712-7639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13198363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty