Provider Demographics
NPI:1699265538
Name:GLASCO, CHRISTOPHER SCOTT (CAA)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:GLASCO
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MALL BLVD STE T
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4861
Mailing Address - Country:US
Mailing Address - Phone:912-355-7214
Mailing Address - Fax:
Practice Address - Street 1:400 MALL BLVD STE T
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4861
Practice Address - Country:US
Practice Address - Phone:912-355-7214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8819367H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant