Provider Demographics
NPI:1982644407
Name:HARNETT, GLENN E (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:E
Last Name:HARNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 RIVERCHASE OFFICE RD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1836
Mailing Address - Country:US
Mailing Address - Phone:205-421-2122
Mailing Address - Fax:205-982-7882
Practice Address - Street 1:1680 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-4906
Practice Address - Country:US
Practice Address - Phone:205-979-0888
Practice Address - Fax:205-979-4110
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052451207P00000X
SC27336207P00000X
AL31023208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA801486406BMedicaid
GA10058667OtherAMERIGROUP
GA801486406AMedicaid
GU801486406DMedicaid
SC801486406FMedicaid
GA801486406HMedicaid
GA801486406EMedicaid
SCG52451Medicaid
SCI056518055Medicare PIN
GA801486406BMedicaid
SCP00187161Medicare PIN
SCG52451Medicaid
GA93BBGQHMedicare PIN