Organization
GLENN E. FUSSELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN E. FUSSELL M.D. (OWNER)
(706) 324-4177
Entity
Organization
Contact information
Practice address
2827 WARM SPRINGS RD, SUITE 3B, COLUMBUS, GA 31904-5246
(706) 324-4177
(706) 322-9637
Mailing address
2827 WARM SPRINGS RD, SUITE 3B, COLUMBUS, GA 31904-5246
(706) 324-4177
(706) 322-9637
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
026777
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330063C
—
GA
01
—
08BDPHD
MEDICARE PTAN
—
01
—
DG5108
RAILROAD MEDICARE GRP NUM
GA
01
—
GRP4568
MEDICARE, PTAN
—
Enumeration date
12/11/2007
Last updated
03/31/2008
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