Basic Information
| Provider Information | |||||||||
| NPI: | 1982644407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARNETT | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2147 RIVERCHASE OFFICE RD | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352441836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054212122 | ||||||||
| FaxNumber: | 2059827882 | ||||||||
| Practice Location | |||||||||
| Address1: | 1680 MONTGOMERY HWY | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352164906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059790888 | ||||||||
| FaxNumber: | 2059794110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 08/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 052451 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 27336 | SC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208D00000X | 31023 | AL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 801486406B | 05 | GA | MEDICAID | 10058667 | 01 | GA | AMERIGROUP | OTHER | 801486406A | 05 | GA | MEDICAID | 801486406D | 05 | GU | MEDICAID | 801486406F | 05 | SC | MEDICAID | 801486406H | 05 | GA | MEDICAID | 801486406E | 05 | GA | MEDICAID | G52451 | 05 | SC | MEDICAID |