Active NPI
Glenda Louise Wrenn Gordon, MD
- Psychiatry Physician
- Atlanta, GA
National Provider Identifier
1750447496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 65812
- Practice address
- 75 Piedment Ave
Ste 700
Atlanta, GA 30303 - Phone
- (404) 756-1400
- Fax
- (404) 736-1453
- NPI assigned
- Dec 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | BW9922522 | PA | |
| Psychiatry Physician | 2084P0800X | MD429700 | PA | |
| Psychiatry Physician | 2084P0800X | MT184680 | PA | |
| Psychiatry Physician | 2084P0800X | 65812 | GA | Primary |
Addresses
Primary practice location
75 Piedment Ave
Ste 700
Atlanta, GA 30303
Mailing address
720 Westview Dr SW
Harris BLDG., 100-a
Atlanta, GA 30310
Phone (404) 756-1400
Other names 1
- Glenda Louise Wrenn
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME145525 | FL | MD | Pediatric Orthopaedic Surgery Physician |
| MD429700 | PA | MD | Psychiatry Physician |
| MT184680 | PA | MD | Psychiatry Physician |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Cardiovascular Disease Physician
- Atlanta, GA
- NPI 1801832324
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623110400000",
"number": "1750447496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 WESTVIEW DR SW",
"address_2": "HARRIS BLDG., 100-A",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30310",
"telephone_number": "404-756-1400",
"fax_number": "404-756-5274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 PIEDMENT AVE",
"address_2": "STE 700",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30303",
"telephone_number": "404-756-1400",
"fax_number": "404-736-1453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WRENN GORDON",
"first_name": "GLENDA",
"middle_name": "LOUISE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-28",
"last_updated": "2021-06-08",
"certification_date": "2021-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "BW9922522",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "MD429700",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "MT184680",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "65812",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "GLENDA",
"last_name": "WRENN",
"middle_name": "LOUISE",
"credential": "M.D.",
"code": "2",
"type": "Professional Name"
}
]
}
Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.