Provider Information for 1558928796
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ROBERT JAY GLICK MA
Sex: Male
NPI: 1558928796
Last Updated: 2023-07-27
Certification Date: 2023-07-27
Certification Date: 2023-07-27
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1558928796 | ||||||||
| Enumeration Date | 2019-05-23 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 450 WINN WAY DECATUR, GA 30030-1715 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 450 WINN WAY DECATUR, GA 30030-1715 United States Phone: 404-294-3745 | Fax: | ||||||||
| Secondary Practice Address(es) | 1605 MORGANS LANDING DR | ||||||||
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