Provider Demographics
NPI:1811952823
Name:GLASS, PAUL J (MD)
Entity type:Individual
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First Name:PAUL
Middle Name:J
Last Name:GLASS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2256 NORTHLAKE PARKWAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4004
Mailing Address - Country:US
Mailing Address - Phone:770-491-0105
Mailing Address - Fax:770-934-6201
Practice Address - Street 1:2256 NORTHLAKE PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4034
Practice Address - Country:US
Practice Address - Phone:770-491-0105
Practice Address - Fax:770-934-6201
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2016-12-12
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Provider Licenses
StateLicense IDTaxonomies
GA026278207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A65213Medicare UPIN