Provider Demographics
NPI:1740540830
Name:ROBERT V. GLOVER, JR., M.D., P.C.
Entity type:Organization
Organization Name:ROBERT V. GLOVER, JR., M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:V
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:229-432-1818
Mailing Address - Street 1:810 13TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1333
Mailing Address - Country:US
Mailing Address - Phone:229-432-1818
Mailing Address - Fax:229-432-1933
Practice Address - Street 1:810 13TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1333
Practice Address - Country:US
Practice Address - Phone:229-432-1818
Practice Address - Fax:229-432-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036161207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000531803AMedicaid
GAF47716Medicare UPIN
GAIIBDFVJMedicare PIN