# COLLIER B. GLADIN, JR., M.D., LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COLLIER B. GLADIN, JR. M.D., LLC
- **Other names:** Collier B Gladin Jr MD
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1780992198
- **Legal business name:** COLLIER B. GLADIN, JR. M.D., LLC
- **Authorized official:** DR. COLLIER B. GLADIN JR. M.D. (OWNER)
- **Authorized official phone:** (478) 757-8335

## Contact information

- **Practice address:** 140 NORTHCREST BLVD., MACON, GA 31210
- **Practice address phone:** (478) 757-8335
- **Practice address fax:** (478) 757-8353
- **Mailing address:** 140 NORTHCREST BLVD., MACON, GA 31210
- **Mailing address phone:** (478) 757-8335
- **Mailing address fax:** (478) 757-8353

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 030609 | GA | Yes |
| 305R00000X | Preferred Provider Organization | 030609 | GA | — |

## Other

- **Enumeration date:** 09/20/2010
- **Last updated:** 03/07/2023