Provider Demographics
NPI:1396561817
Name:GLOGOWSKI, SYDNIE
Entity type:Individual
Prefix:
First Name:SYDNIE
Middle Name:
Last Name:GLOGOWSKI
Suffix:
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 1:132 RIVERCREST LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5439
Mailing Address - Country:US
Mailing Address - Phone:904-524-6614
Mailing Address - Fax:
Practice Address - Street 1:132 RIVERCREST LN
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5439
Practice Address - Country:US
Practice Address - Phone:904-524-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant