Organization
GLYNN UROLOGISTS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK M. AMIE JR. M.D. (PRESIDENT)
(912) 264-6362
Entity
Organization
Contact information
Practice address
2418 PARKWOOD DR, BRUNSWICK, GA 31520-4721
(912) 264-6362
(912) 264-6352
Mailing address
2418 PARKWOOD DR, BRUNSWICK, GA 31520-4721
(912) 264-6362
(912) 264-6352
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
014120
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00083861A
—
GA
Enumeration date
12/05/2006
Last updated
05/22/2020
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