Provider Demographics
NPI:1417763434
Name:GLANTON, DURMOND LAVELL
Entity type:Individual
Prefix:
First Name:DURMOND
Middle Name:LAVELL
Last Name:GLANTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 ROLAND MANOR DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-6584
Mailing Address - Country:US
Mailing Address - Phone:470-361-9936
Mailing Address - Fax:
Practice Address - Street 1:505 ROLAND MANOR DR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-6584
Practice Address - Country:US
Practice Address - Phone:470-361-9936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician