Provider Demographics
NPI:1437564846
Name:GLENN, STEVEN JOSHUA (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOSHUA
Last Name:GLENN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:719 GREEN VALLEY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7022
Mailing Address - Country:US
Mailing Address - Phone:336-230-1010
Mailing Address - Fax:336-230-1019
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:BA-2720
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-1160
Practice Address - Fax:706-721-1158
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL37052390200000X
GA7480207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program