Individual
JONATHAN COLEMAN GLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
716 E 71ST ST, SAVANNAH, GA 31405-4907
(912) 355-1533
(912) 355-5984
Mailing address
721 OKATIE HWY # 170, OKATIE, SC 29909-3963
(843) 987-7400
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
21984
GA
207R00000X
Internal Medicine Physician
Primary
7816
SC
207RG0100X
Gastroenterology Physician
7816
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00234429A
—
GA
05
—
G07186
—
SC
Enumeration date
01/08/2007
Last updated
03/11/2020
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