Provider Demographics
NPI:1932195013
Name:GLANDER, SUSAN STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:STEPHEN
Last Name:GLANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:JANIS
Other - Last Name:GLANDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5780 PEACHTREE DUNWOODY ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-1224
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:1121 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5425
Practice Address - Country:US
Practice Address - Phone:770-977-1510
Practice Address - Fax:770-509-8858
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042579207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000656565MMedicaid
GA000656565KMedicaid
GA000656565LMedicaid
GAG72851Medicare UPIN