Provider Demographics
NPI:1629660568
Name:GLASS, YVETTE TONKIA (SURGICAL TECH)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:TONKIA
Last Name:GLASS
Suffix:
Gender:F
Credentials:SURGICAL TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42923
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-9004
Mailing Address - Country:US
Mailing Address - Phone:678-381-9820
Mailing Address - Fax:
Practice Address - Street 1:3975 N MARTIN WAY
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2018
Practice Address - Country:US
Practice Address - Phone:678-381-9820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist