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General NPI Number Information
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NPI Number | 1699698431
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Entity Type | Organization
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Legal Business Name | GLEGEN MEDICAL GA INC
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Dates
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Enumeration Date | 07/30/2026
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Last Update Date | 07/30/2026
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Provider Practice Location Address
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Address Line | 422 LEE ST
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City | JEFFERSON
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State | GA
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Zip | 30549-1352
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Country | US
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Telephone | 877-340-1697
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Fax |
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Provider Business Mailing Address
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Address Line | 8735 DUNWOODY PL # GA3035
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City | SANDY SPRINGS
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State | GA
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Zip | 30350-2995
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICALOFFICER
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Name | DR. GLEB GENDEL
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Credential | DO
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Telephone | 877-340-1697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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