Individual
GLENN EDWARD FUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2827 WARM SPRINGS RD, SUITE 3-B, COLUMBUS, GA 31904-5246
(706) 324-4177
Mailing address
2827 WARM SPRINGS RD, SUITE 3-B, COLUMBUS, GA 31904-5246
(706) 324-4177
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
026777
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330063C
—
GA
01
—
6485960001
NSC PTAN
GA
Enumeration date
08/23/2006
Last updated
01/31/2014
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