Provider Demographics
NPI:1801906433
Name:GLOVER, FRANK EUGENE JR (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:EUGENE
Last Name:GLOVER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2155
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799
Mailing Address - Country:US
Mailing Address - Phone:229-227-0086
Mailing Address - Fax:229-227-5929
Practice Address - Street 1:817 SMITH AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792
Practice Address - Country:US
Practice Address - Phone:229-227-0086
Practice Address - Fax:229-227-5929
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034521208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00698937EMedicaid
GAGRP3963Medicare PIN
GA34BDFFB01Medicare ID - Type Unspecified
GA00698937EMedicaid