Provider Demographics
NPI:1588620009
Name:MCGLAMRY, MICHAEL C (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:MCGLAMRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MARY ALICE PARK DRIVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2697
Mailing Address - Country:US
Mailing Address - Phone:678-262-4040
Mailing Address - Fax:678-262-4060
Practice Address - Street 1:102 MARY ALICE PARK DRIVE
Practice Address - Street 2:SUITE 502
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2697
Practice Address - Country:US
Practice Address - Phone:678-262-4040
Practice Address - Fax:678-262-4060
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000680213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA336208705Medicaid
GA336208705ABMedicaid
GA336208705ABMedicaid
GAP00272705Medicare PIN
GA202I485673Medicare PIN
GA202I487460Medicare PIN
GAU51791Medicare UPIN
GA48SCCTHMedicare PIN