Organization
NOVA MEDICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD GLASS JR. (DIRECTOR)
(770) 812-3928
Entity
Organization
Contact information
Practice address
20 HERRELL RD, VILLA RICA, GA 30180-5527
(770) 726-7460
Mailing address
PO BOX 1149, VILLA RICA, GA 30180-6149
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003228138A
—
GA
Enumeration date
01/29/2019
Last updated
10/11/2021
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