Individual
KIMBERLEY GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
960 WOODSTOCK PKWY, SUITE 300, WOODSTOCK, GA 30188-4866
(770) 517-2145
(770) 517-2147
Mailing address
960 WOODSTOCK PKWY, SUITE 300, WOODSTOCK, GA 30188-4866
(770) 517-2145
(770) 517-2147
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
007388
GA
363A00000X
Physician Assistant
013821
NY
Other
Enumeration date
01/13/2010
Last updated
01/10/2017
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