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Individual

KENNETH ANDREW GLASS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CAA

Contact information

Practice address
1000 JOHNSON FY RD NE, ATLANTA, GA 30342-1606
(559) 676-6956
Mailing address
4675 OLD STILESBORO RD NW, ACWORTH, GA 30101-4067
(559) 676-6956

Taxonomy

Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
8017
GA

Other

Enumeration date
08/28/2018
Last updated
08/28/2018
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