Individual
CHARLES LAWRENCE GLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2995 REIDVILLE RD STE 210, SPARTANBURG, SC 29301-5631
(864) 253-8140
(864) 587-0051
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13363
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133634
—
SC
01
—
SCE4635019
MEDICARE PIN
SC
Enumeration date
05/19/2006
Last updated
03/13/2019
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