Provider Demographics
NPI:1245371426
Name:GLASS, JOSHUA H (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:H
Last Name:GLASS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:754 PEACHTREE ST NE STE 105
Mailing Address - Street 2:AT & T RETAIL MALL
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1256
Mailing Address - Country:US
Mailing Address - Phone:404-872-4878
Mailing Address - Fax:404-872-4846
Practice Address - Street 1:754 PEACHTREE ST NE STE 105
Practice Address - Street 2:AT & T RETAIL MALL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1256
Practice Address - Country:US
Practice Address - Phone:404-872-4878
Practice Address - Fax:404-872-4846
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6980111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician