Individual provider Active NPI

Glenda Louise Wrenn Gordon, MD

  • Psychiatry Physician
  • Atlanta, GA
National Provider Identifier
1750447496
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
65812 Issued in GA
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

Updated by the provider on Jun 8, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
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 Professional name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110726000071 GA Practitioner - Psychiatry 6406943646 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME145525FLMDPediatric Orthopaedic Surgery Physician
MD429700PAMDPsychiatry Physician
MT184680PAMDPsychiatry 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.

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

Verify at the official NPI Registry.