Individual
BENITA Y GLOVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
80 W INDEPENDENCE CIR, MCDONOUGH, GA 30253-6550
(678) 724-6454
Mailing address
80 W INDEPENDENCE CIR, MCDONOUGH, GA 30253-6550
(678) 724-6454
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
058988264
GA
Other
Enumeration date
08/10/2021
Last updated
08/10/2021
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