Provider Demographics
NPI:1174928725
Name:GLOVER, CAMESHA NAKIA (BUSINESS LICENSE)
Entity type:Individual
Prefix:
First Name:CAMESHA
Middle Name:NAKIA
Last Name:GLOVER
Suffix:
Gender:F
Credentials:BUSINESS LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 PARKDALE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-1411
Mailing Address - Country:US
Mailing Address - Phone:404-553-6179
Mailing Address - Fax:
Practice Address - Street 1:684 PARKDALE DR
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:GA
Practice Address - Zip Code:30079-1411
Practice Address - Country:US
Practice Address - Phone:404-553-6179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA464426693163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health