Healthcare Provider Details

I. General information

NPI: 1699698431
Provider Name (Legal Business Name): GLEGEN MEDICAL GA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 LEE ST
JEFFERSON GA
30549-1352
US

IV. Provider business mailing address

8735 DUNWOODY PL # GA3035
SANDY SPRINGS GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 877-340-1697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GLEB GENDEL
Title or Position: MEDICALOFFICER
Credential: DO
Phone: 877-340-1697