GLEN A VAHJEN MD (Credential# 157085) is licensed (Controlled Substance Registration for Practitioner) with Connecticut Department of Consumer Protection. The license effective date is March 1, 2019. The license expiration date date is February 28, 2021. The license status is ACTIVE.
GLEN A VAHJEN MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #CSP.0015733. The credential type is controlled substance registration for practitioner. The effective date is March 1, 2019. The expiration date is February 28, 2021. The business address is 3200 Old River Rd, Fortson, GA 31808. The current status is active.
| Licensee Name | GLEN A VAHJEN MD |
| Credential ID | 157085 |
| Credential Number | CSP.0015733 |
| Credential Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| Business Address |
3200 Old River Rd Fortson GA 31808 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1999-03-01 |
| Effective Date | 2019-03-01 |
| Expiration Date | 2021-02-28 |
| Refresh Date | 2019-01-11 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 546380 | 1.027121 | Physician/Surgeon | 1986-03-27 | 2019-11-01 - 2020-10-31 | ACTIVE |
| Street Address | 3200 OLD RIVER RD |
| City | FORTSON |
| State | GA |
| Zip Code | 31808 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Mayuri B Patel | P.o Box 143, Fortson, GA 31808 | Registered Nurse | 2019-09-01 ~ 2020-08-31 |
| Sarah E Richter | 363 Morton Court, Fortson, GA 31808 | Registered Nurse | 2001-02-02 ~ 2001-10-31 |
| Judson D Smith | 95 Spruce Drive, Fortson, GA 31808 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Lorna L Rawle Aprn | 40 Grizzly Ln, Fortson, GA 31808-4491 | Controlled Substance Registration for Practitioner | 2009-11-03 ~ 2011-02-28 |
| Laura Ng | 4499 English Ivy Dr, Fortson, GA 31808-6884 | Registered Nurse | 2019-08-21 ~ 2020-08-31 |
| City | FORTSON |
| Zip Code | 31808 |
| License Type | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER |
| License Type + County | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER + FORTSON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Ping Ge | 90 Glen Ridge Rd, Hamden, CT 06518-5360 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| K Paul Rumble Dvm | 28 Glen St, Milford, CT 06460-6526 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Asma Zia | 12 Hospital Dr, Glen Buenie, MO | Controlled Substance Registration for Practitioner | 2009-08-07 ~ 2011-02-28 |
| Kiin Kim | 51 Valley Rd, Glen Rock, NJ 07452-1711 | Controlled Substance Registration for Practitioner | 2017-03-15 ~ 2019-02-28 |
| Glen R Hacker | 7 Whitney St Ext, Westport, CT 06880-3761 | Controlled Substance Registration for Practitioner | 2019-03-18 ~ 2021-02-28 |
| Amanda Mckenzie | 65 Glen St, Berlin, CT 06037-2022 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Erin N Lyons Pa-c | 60 Glen Rd Apt 110, Brookline, MA 02445-7731 | Controlled Substance Registration for Practitioner | 2015-02-27 ~ 2017-02-28 |
| Olivia D Carter | 213 Glen St, New Britain, CT 06051-3027 | Controlled Substance Registration for Practitioner | 2019-01-07 ~ 2021-02-28 |
| Lan Zhang Md | 8 Old Farm Ct, Glen Head, NY 11545 | Controlled Substance Registration for Practitioner | 2004-02-29 ~ 2005-02-28 |
| Tasmeem Ahmad | 914 Aspen Glen Dr, Hamden, CT 06518-5312 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).