Individual
TAHIRA KANEKA LOVE-GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
3565 GEORGIA HIGHWAY 20 SE, CONYERS, GA 30013-2800
(404) 430-1757
Mailing address
3989 CUMBERLAND TRL SE, CONYERS, GA 30094-3889
(770) 286-6992
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN239826
GA
363LA2200X
Adult Health Nurse Practitioner
Primary
RN239826
GA
363LG0600X
Gerontology Nurse Practitioner
RN239826
GA
363LP2300X
Primary Care Nurse Practitioner
RN239826
GA
Other
Enumeration date
01/23/2019
Last updated
08/10/2024
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