Provider Demographics
NPI:1669925038
Name:GLOVER, VONARICA
Entity type:Individual
Prefix:
First Name:VONARICA
Middle Name:
Last Name:GLOVER
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 1:69 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2719
Mailing Address - Country:US
Mailing Address - Phone:478-742-7748
Mailing Address - Fax:478-742-8930
Practice Address - Street 1:69 DAVIS ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2719
Practice Address - Country:US
Practice Address - Phone:478-742-7748
Practice Address - Fax:478-742-8930
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant