Provider Demographics
NPI:1326471715
Name:GARLAND, GWENDOLYN MACHELLE (EDD)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:MACHELLE
Last Name:GARLAND
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-1643
Mailing Address - Country:US
Mailing Address - Phone:470-214-1070
Mailing Address - Fax:770-467-9680
Practice Address - Street 1:1104 N 2ND ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1643
Practice Address - Country:US
Practice Address - Phone:470-214-1070
Practice Address - Fax:770-467-9680
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC002519OtherSTATE OF GEORGIA