Basic Information
Provider Information | |||||||||
NPI: | 1356846216 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | GLANCY HOSPITALIST GROUP LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1331 | ||||||||
Address2: |   | ||||||||
City: | HARTWELL | ||||||||
State: | GA | ||||||||
PostalCode: | 306436331 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4045835019 | ||||||||
FaxNumber: | 7706647379 | ||||||||
Practice Location | |||||||||
Address1: | 3215 MCCLURE BRIDGE RD | ||||||||
Address2: |   | ||||||||
City: | DULUTH | ||||||||
State: | GA | ||||||||
PostalCode: | 300963223 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6783126010 | ||||||||
FaxNumber: | 7706647379 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/24/2018 | ||||||||
LastUpdateDate: | 03/31/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BHOLE | ||||||||
AuthorizedOfficialFirstName: | SUNIL | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | MD | ||||||||
AuthorizedOfficialTelephone: | 4046730308 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/31/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |   |
No ID Information.