| NPI | 1376237354 |
|---|---|
| Former Legal Business Name | GLAM TOWN MEDICAL & SPA LLC |
| Entity Type | Organization |
| Authorized Contact | RONDA JOY COCHRAN Administrator 478-304-0606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine |
| 261Q00000X Clinic/Center | |
| 261QH0100X Clinic/Center, Health Services | |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2024-07-09 |