Provider Demographics
NPI:1710052105
Name:MCALPIN, GLENN MARK (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:MARK
Last Name:MCALPIN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ROSCOE RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1112
Mailing Address - Country:US
Mailing Address - Phone:678-656-3054
Mailing Address - Fax:770-502-6530
Practice Address - Street 1:28 ROSCOE RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1112
Practice Address - Country:US
Practice Address - Phone:678-656-3054
Practice Address - Fax:770-502-6530
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126137208600000X, 2086S0102X
GA37865208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00590477AMedicaid
02BDCJCMedicare ID - Type Unspecified
B46434Medicare UPIN