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Organization
ANU GLO MED SPA, LLC.
Active
Organization
ANU GLO MED SPA, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVY CLEVELAND NP (OWNER)
(404) 664-2505
Entity
Organization
Contact information
Practice address
2429 MAIN ST E STE 6, SNELLVILLE, GA 30078-3336
(404) 664-2505
Mailing address
1573 STONEGATE WAY, SNELLVILLE, GA 30078-6701
(404) 664-2505
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
363LA2100X
Acute Care Nurse Practitioner
—
NULL
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
Primary
—
NULL
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
NULL
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
09/01/2020
Last updated
09/01/2020
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