Provider Demographics
NPI:1689620536
Name:GLAUDE, DENNIS LEO (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LEO
Last Name:GLAUDE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2564
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31203
Mailing Address - Country:US
Mailing Address - Phone:478-746-5644
Mailing Address - Fax:478-745-4849
Practice Address - Street 1:380 HOSPITAL DR.
Practice Address - Street 2:SUITE 410
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8014
Practice Address - Country:US
Practice Address - Phone:706-282-4200
Practice Address - Fax:706-886-8045
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN078329367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA580628385OtherTRICARE
GA000547797FMedicaid
GAP00257335OtherMEDICARE RAILROAD
GA003105057AMedicaid
GA511I430107Medicare PIN
GA003105057AMedicaid
GA580628385OtherTRICARE