Provider Demographics
NPI:1215066311
Name:FILMORE, GLORIA JEAN (RN)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:JEAN
Last Name:FILMORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 8TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-1927
Mailing Address - Country:US
Mailing Address - Phone:229-377-7877
Mailing Address - Fax:229-227-5447
Practice Address - Street 1:1102 SMITH AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5739
Practice Address - Country:US
Practice Address - Phone:229-227-5477
Practice Address - Fax:229-227-5447
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN064938163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN064938OtherRN LICENSE