Individual
REGINA DIXON GLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11647 HIGHWAY 225 N, CRANDALL, GA 30711-6315
(706) 517-8830
(706) 517-0553
Mailing address
11647 HIGHWAY 225 N, CRANDALL, GA 30711-6315
(706) 517-8830
(706) 517-0553
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/30/2007
Last updated
11/30/2007
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