Individual
DR. RICHARD GLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
20 HERRELL RD, VILLA RICA, GA 30180-5527
(770) 456-3929
Mailing address
PO BOX 1149, VILLA RICA, GA 30180-6149
(404) 858-1063
(770) 456-4691
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
062989
GA
207Q00000X
Family Medicine Physician
250913
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
344112558A
—
GA
Enumeration date
12/22/2008
Last updated
10/11/2021
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