Provider Demographics
NPI:1598037434
Name:JASON, GLORY (RN,NP)
Entity Type:Individual
Prefix:MRS
First Name:GLORY
Middle Name:
Last Name:JASON
Suffix:
Gender:F
Credentials:RN,NP
Other - Prefix:MRS
Other - First Name:GLORY
Other - Middle Name:MATHEWS
Other - Last Name:JASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN,NP
Mailing Address - Street 1:4995 LANIER ISLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1741
Mailing Address - Country:US
Mailing Address - Phone:678-546-5059
Mailing Address - Fax:678-546-5470
Practice Address - Street 1:4995 LANIER ISLANDS PKWY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1741
Practice Address - Country:US
Practice Address - Phone:678-546-5059
Practice Address - Fax:678-546-5470
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN158040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily