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Individual

JOHN V GLISSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
725 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3834
(770) 535-3611
(770) 535-7092
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 535-7445

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
028406
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000324266C
GA
05
000324266D
GA
05
000324266E
GA
05
000324266F
GA
05
000324266G
GA
01
10032977
AMERIGROUP
GA
01
1207078
UNITED HEALTHCARE
GA
01
1910980
CIGNA
GA
01
303911
WELLCARE
GA
01
303925
WELLCARE
GA
01
303930
WELLCARE
GA
01
303933
WELLCARE
GA
01
4104400
AETNA PPO
GA
01
52024741
BCBS
GA
01
531448
WELLCARE
GA
01
958571
AETNA HMO
GA
Enumeration date
01/18/2006
Last updated
08/17/2011
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