Individual
MR. DENNIS LEO GLAUDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
380 HOSPITAL DR., SUITE 410, MACON, GA 31217-8014
(706) 282-4200
(706) 886-8045
Mailing address
P.O. BOX 2564, MACON, GA 31203
(478) 746-5644
(478) 745-4849
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN078329
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000547797F
—
GA
05
—
003105057A
—
GA
01
—
580628385
TRICARE
GA
01
—
P00257335
MEDICARE RAILROAD
GA
Enumeration date
05/25/2006
Last updated
02/07/2011
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