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Organization
VIDRO INDUSTRIES, LLC
Active
Organization
VIDRO INDUSTRIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD GLASS JR. M.D. (CEO)
(770) 456-4691
Entity
Organization
Contact information
Practice address
20 HERRELL RD, VILLA RICA, GA 30180-5527
(770) 456-4691
Mailing address
PO BOX 1149, VILLA RICA, GA 30180-6149
(770) 456-4691
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
062989
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
344112558A
—
GA
Enumeration date
02/16/2011
Last updated
06/27/2013
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