Provider Demographics
NPI:1750447496
Name:WRENN GORDON, GLENDA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:LOUISE
Last Name:WRENN GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:LOUISE
Other - Last Name:WRENN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:720 WESTVIEW DR SW
Mailing Address - Street 2:HARRIS BLDG., 100-A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310
Mailing Address - Country:US
Mailing Address - Phone:404-756-1400
Mailing Address - Fax:404-756-5274
Practice Address - Street 1:75 PIEDMENT AVE
Practice Address - Street 2:STE 700
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-756-1400
Practice Address - Fax:404-736-1453
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABW99225222084P0800X
PAMD4297002084P0800X
PAMT1846802084P0800X
GA658122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry