Provider Demographics
NPI:1730174905
Name:GLASPY-BENTON, ELEANOR (MD)
Entity type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:
Last Name:GLASPY-BENTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8954 HOSPITAL DR
Mailing Address - Street 2:SUITE 120-A
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2272
Mailing Address - Country:US
Mailing Address - Phone:770-732-7987
Mailing Address - Fax:770-732-2989
Practice Address - Street 1:8954 HOSPITAL DR
Practice Address - Street 2:SUITE 120-A
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2272
Practice Address - Country:US
Practice Address - Phone:770-732-7987
Practice Address - Fax:770-732-2989
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033093207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00643783BMedicaid
GA00643783BMedicaid
GAG17339Medicare UPIN