Provider Demographics
NPI:1386928091
Name:GLOVER, MARSHA DEON
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:DEON
Last Name:GLOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PERIMETER PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1329
Mailing Address - Country:US
Mailing Address - Phone:479-201-8210
Mailing Address - Fax:
Practice Address - Street 1:30 PERIMETER PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1329
Practice Address - Country:US
Practice Address - Phone:479-201-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC006025183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician