Individual
GLENN N CARLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4700 WATERS AVE STE 403, SAVANNAH, GA 31404-6220
(912) 273-1150
Mailing address
250 N SHADELAND AVE, SUITE 130- PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01046364A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
01046364A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
94975
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000834804
ANTHEM PIN
IN
05
—
200013190
—
IN
Enumeration date
09/27/2006
Last updated
05/10/2023
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