Individual
GEORGE W GLAZEBROOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
80 INTERSTATE SOUTH DR, STE B, JASPER, GA 30143-6226
(706) 692-9081
(706) 692-0155
Mailing address
80 INTERSTATE SOUTH DR, STE B, JASPER, GA 30143-6226
(706) 692-9081
(706) 692-0155
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
16348
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00038519A
—
GA
01
—
020034782
RAILROAD MEDICARE
GA
01
—
102136
BLUE CROSS BLUE SHIELD
GA
Enumeration date
04/05/2006
Last updated
01/23/2012
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