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Individual

GLEN ALLEN HIDDEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
50 E HOSPITAL ST, SUITE 4, MANNING, SC 29102-3149
(803) 435-5250
(803) 435-5255
Mailing address
50 E HOSPITAL ST, SUITE 4, MANNING, SC 29102-3149
(803) 435-5250
(803) 435-5255

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
043063
GA
207Q00000X
Family Medicine Physician
Primary
22420
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
872533996A
GA
Enumeration date
07/22/2006
Last updated
10/17/2010
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