Individual
DR. GLEN JOSEPH IANNUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3300 OLD MILTON PKWY STE 100, ALPHARETTA, GA 30005-2425
(404) 256-2593
(770) 488-9408
Mailing address
2970 BRANDYWINE RD STE 125, ATLANTA, GA 30341-5521
(404) 256-2593
(770) 488-9408
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
002845
GA
2080P0202X
Pediatric Cardiology Physician
Primary
064569
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002845
RESTRAINING PERMIT #
GA
05
—
003100495C
—
GA
Enumeration date
12/28/2007
Last updated
04/23/2026
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