Healthcare Provider Details

I. General information

NPI: 1366677635
Provider Name (Legal Business Name): WENDY FARRAR GELFOND FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY DIANNE FARRAR RN

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON ROAD NE
ATLANTA GA
30322
US

IV. Provider business mailing address

531 ASBURY CIRCLE SUITE A340
ATLANTA GA
30322
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5975
  • Fax: 404-778-2630
Mailing address:
  • Phone: 404-778-5975
  • Fax: 404-778-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN177304
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN177304
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: