Provider Demographics
NPI:1053391979
Name:GLISSON, JOHN V (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:GLISSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-535-3611
Practice Address - Fax:770-535-7092
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA028406208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000324266DMedicaid
GA303930OtherWELLCARE
GA000324266CMedicaid
GA000324266EMedicaid
GA1207078OtherUNITED HEALTHCARE
GA000324266FMedicaid
GA000324266GMedicaid
GA303911OtherWELLCARE
GA303925OtherWELLCARE
GA1910980OtherCIGNA
GA303933OtherWELLCARE
GA4104400OtherAETNA PPO
GA52024741OtherBCBS
GA10032977OtherAMERIGROUP
GA531448OtherWELLCARE
GA958571OtherAETNA HMO
GA1207078OtherUNITED HEALTHCARE
GA52024741OtherBCBS