Individual
OLIVER MATHEW GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 WISTERIA DR, GAINESVILLE, GA 30501-3827
(770) 219-5907
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
77745
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/19/2013
Last updated
01/07/2021
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