CHRISTOPHER BLAKE GLAZE (NPI# 1104464296) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104464296 |
| Entity Type | Individual |
| Full Name | CHRISTOPHER BLAKE GLAZE |
| Practice Address |
122 Gordon Commercial Dr Ste C Lagrange GA 30240-5754 |
| Mailing Address |
709 S 12th St Lanett AL 36863-2831 |
| Practice Telephone | 7068454045 |
| Mailing Telephone | 7065902839 |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2019-12-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528467321 | Christopher Glaze | Physical Therapist | 2714 W Oxford Loop Ste 164, Oxford, MS 38655-5717 | 2014-08-18 |
| Street Address |
122 GORDON COMMERCIAL DR STE C |
| City | LAGRANGE |
| State | GA |
| Zip Code | 30240-5754 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083938492 | Melissa Ann Johnson | Counselor | 122 Gordon Commercial Dr Ste C, Lagrange, GA 30240-5754 | 2010-03-15 |
| 1689282220 | Sherjuana Davis | Social Worker | 122 Gordon Commercial Dr Ste C, Lagrange, GA 30240-5754 | 2020-07-20 |
| 1821636846 | Katie Kinsey | Case Manager/Care Coordinator | 122 Gordon Commercial Dr Ste C, Lagrange, GA 30240-5754 | 2019-12-20 |
| 1134767361 | Forrest Johnson | Case Manager/Care Coordinator | 122 Gordon Commercial Dr Ste C, Lagrange, GA 30240-5754 | 2019-12-18 |
| 1033755475 | Zenetta Michelle Harris | Licensed Practical Nurse | 122 Gordon Commercial Dr Ste C, Lagrange, GA 30240-5754 | 2019-11-20 |
| 1760023915 | Mariana Garcia | Case Manager/Care Coordinator | 122 Gordon Commercial Dr Ste C, Lagrange, GA 30240-5754 | 2019-09-30 |
| 1134770274 | Jennie Laplant | Counselor | 122 Gordon Commercial Dr Ste C, Lagrange, GA 30240-5754 | 2019-09-20 |
| 1427608652 | Robin Wilson | Licensed Practical Nurse | 122 Gordon Commercial Dr Ste C, Lagrange, GA 30240-5754 | 2019-09-19 |
| 1912555103 | Sophia Vaughn | Contractor | 122 Gordon Commercial Dr Ste C, Lagrange, GA 30240-5754 | 2019-08-30 |
| 1992352173 | Joann Hawkins | Licensed Practical Nurse | 122 Gordon Commercial Dr Ste C, Lagrange, GA 30240-5754 | 2019-08-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598223844 | Urgencare, LLC | Clinic/Center | 2169 West Point Road, Suite 105, Lagrange, GA 30240 | 2019-03-06 |
| 1679075527 | Georgia Pain and Spine Care, Inc | Pain Medicine | 303 Smith St Fl 2, Lagrange, GA 30240 | 2018-03-07 |
| 1629463500 | Quoc Vinh Ngo | Emergency Medicine | Wellstar West Georgia Medical Center, 1504 Vernon Road, Lagrange, GA 30240 | 2015-03-30 |
| 1770913964 | Dell H Lawson | Counselor | 300 Medical Dr. Ste 705., Lagrange, GA 30240 | 2013-11-25 |
| 1629418793 | Mortar & Pestle, LLC | Pharmacy | 205 Vernon Street, Lagrange, GA 30240 | 2013-07-03 |
| 1336582329 | Weredeselam Menna Olango | Psychiatry & Neurology | 303 Medical Dr Ste 401, Lagrange, GA 30240 | 2013-04-10 |
| 1720333743 | Mortar and Pestle, LLC | Pharmacy | 300 Mooty Bridge Road, Lagrange, GA 30240 | 2012-07-16 |
| 1366768459 | Karin Taylor | Physical Medicine & Rehabilitation | 1600 Vernon Rd Ste A, Lagrange, GA 30240 | 2010-04-14 |
| 1871819458 | Kathryn J Hill | Counselor | 100 Smith St Ste 1, Lagrange, GA 30240 | 2010-04-08 |
| 1285802751 | Air Evac Ems, Inc. | Ambulance | 455 Aerotron Pkwy, Lagrange, GA 30240 | 2008-02-18 |
| Find all providers in zip 30240 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609499706 | Vibe Healing Center, LLC | Counselor | 137b Commerce Ave # 188, Lagrange, GA 30241-2337 | 2020-05-22 |
| 1871116459 | Samantha Thomaston | Counselor | 111 Holleys Grove Dr, Lagrange, GA 30240-7761 | 2020-05-18 |
| 1750834024 | Lashannon Patrice Epps | Counselor | 1111 Mooty Bridge Rd Ste A, Lagrange, GA 30240-1742 | 2016-08-03 |
| 1659784833 | Valerie Kuecker Cleveland | Counselor | 122 Gordon Commercial Dr Ste D, Lagrange, GA 30240-5754 | 2014-06-05 |
| 1770913964 | Dell H Lawson | Counselor | 300 Medical Dr. Ste 705., Lagrange, GA 30240 | 2013-11-25 |
| 1356638639 | Deborah Jenkins | Counselor | 62 Tyler St, Lagrange, GA 30240-8837 | 2011-07-07 |
| 1871819458 | Kathryn J Hill | Counselor | 100 Smith St Ste 1, Lagrange, GA 30240 | 2010-04-08 |
| 1609036524 | Jimmy Dawson Mccamey Jr. | Counselor | 419 Ridley Ave, Lagrange, GA 30240-2231 | 2008-06-13 |
| 1952498644 | Kenneth Sheppard Hoats | Counselor | 1507 Vernon Rd, Lagrange, GA 30240-4146 | 2006-10-06 |
| 1700401536 | Angela Montondo | Counselor | 610 Ridley Ave, Lagrange, GA 30240-2236 | 2020-06-08 |
| Find all providers in LAGRANGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.