# SOUTHERN FAMILY HEALTHCARE OF EASTMAN INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902009194
- **Authorized official:** DR. JOHN A GLENN JR. MD (OWNER)
- **Authorized official phone:** (478) 374-1308

## Contact information

- **Practice address:** 1112 PLAZA AVE, SUITE C, EASTMAN, GA 31023-9009
- **Practice address phone:** (478) 374-1308
- **Practice address fax:** (478) 374-0302
- **Mailing address:** 1112 PLAZA AVE STE C, PO BOX 789, EASTMAN, GA 31023-9012
- **Mailing address phone:** (478) 374-1308
- **Mailing address fax:** (478) 374-0302

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 038495 | GA | Yes |

## Other

- **Enumeration date:** 06/06/2007
- **Last updated:** 06/20/2018