Provider Demographics
NPI:1780992198
Name:COLLIER B. GLADIN, JR., M.D., LLC
Entity type:Organization
Organization Name:COLLIER B. GLADIN, JR., M.D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIER
Authorized Official - Middle Name:B
Authorized Official - Last Name:GLADIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:478-757-8335
Mailing Address - Street 1:140 NORTHCREST BLVD.
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210
Mailing Address - Country:US
Mailing Address - Phone:478-757-8335
Mailing Address - Fax:478-757-8353
Practice Address - Street 1:140 NORTHCREST BLVD.
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:478-757-8335
Practice Address - Fax:478-757-8353
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLLIER B. GLADIN, JR. M.D., LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030609305R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000383446DMedicaid
GAD29570OtherUPIN
GAD29570OtherUPIN
GAD29570OtherUPIN
GA08BDPCRMedicare PIN