Individual
DR. GLENN R BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5665 NEW NORTHSIDE DR NW STE 320, ATLANTA, GA 30328-5834
(770) 874-5400
Mailing address
5665 NEW NORTHSIDE DR NW STE 320, ATLANTA, GA 30328-5834
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
64512
GA
Other
Enumeration date
09/10/2007
Last updated
08/12/2010
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