Individual provider Active NPI

Gwendolyn Tanner Gardner, DC

  • Chiropractor
  • Marietta, GA
National Provider Identifier
1609479062
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR009011 Issued in GA
Practice address
1415 Barclay Cir SE
Marietta, GA 30060-2943
Phone
(770) 792-6100
Fax
(770) 792-6113
NPI assigned
Nov 18, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Chiropractor 111NN1001X CHIR009011 GA
Chiropractor 111N00000X CHIR009011 GA Primary

Addresses

Primary practice location

1415 Barclay Cir SE
Marietta, GA 30060-2943

Mailing address

1415 Barclay Cir SE
Marietta, GA 30060-2943
Phone (770) 792-6100

Other practice location 1

1415 Barclay Circle
Harietta, GA 30060
Phone (770) 792-6100 ext. 1939

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIR009011GAMDChiropractor

Interoperability endpoints

  • Direct secure messaging: gwendolyn.gardner.p1@direct.life.nextgenshare.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1609479062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 BARCLAY CIR SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300602943",
            "telephone_number": "770-792-6100",
            "fax_number": "770-792-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 BARCLAY CIR SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300602943",
            "telephone_number": "770-792-6100",
            "fax_number": "770-792-6113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1415 Barclay Circle",
            "address_purpose": "LOCATION",
            "city": "Harietta",
            "state": "GA",
            "postal_code": "30060",
            "country_code": "US",
            "telephone_number": "770-792-6100 x1939",
            "fax_number": "770-792-6113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "GWENDOLYN",
        "middle_name": "TANNER",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-18",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "GA",
            "license": "CHIR009011",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR009011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.