Iannucci, Glen Joseph

Iannucci, Glen Joseph is an individual health care provider with primary practice located at 3300 Old Milton Pkwy Ste 100 , Alpharetta GA 30005-2425. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Cardiology. Allopathic & Osteopathic Physicians / Pediatric Cardiology is his primary health care specialty. Iannucci, Glen Joseph can be contacted via phone (404) 256-2593.

Contact Information

Primary practice address
3300 Old Milton Pkwy Ste 100 Alpharetta GA 30005-2425
Phone: (404) 256-2593
Fax: (770) 488-9408
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 002845 Georgia
Allopathic & Osteopathic Physicians / Pediatric Cardiology 2080P0202X 064569 Georgia

Profile Details

NPI number 1972787760
LBN Legal business name Iannucci, Glen Joseph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 28th, 2007
Last updated Jan 22nd, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972787760 NPPES
Georgia Other 002845 RESTRAINING PERMIT #
Georgia MEDICAID 003100495C RESTRAINING PERMIT #

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