Provider Demographics
NPI:1710352711
Name:GARNER, GLENDORA I
Entity Type:Individual
Prefix:
First Name:GLENDORA
Middle Name:
Last Name:GARNER
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 TIFFANY LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2556
Mailing Address - Country:US
Mailing Address - Phone:740-605-7718
Mailing Address - Fax:
Practice Address - Street 1:1102 TIFFANY LN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2556
Practice Address - Country:US
Practice Address - Phone:740-605-7718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker