Provider Demographics
NPI:1528046539
Name:GLODENER, GIOUZEL (MD)
Entity type:Individual
Prefix:
First Name:GIOUZEL
Middle Name:
Last Name:GLODENER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GUZEL
Other - Middle Name:OLEGOVNA
Other - Last Name:TIKHOMIROVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1845 LOCKEWAY DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5928
Mailing Address - Country:US
Mailing Address - Phone:770-343-9112
Mailing Address - Fax:770-343-8911
Practice Address - Street 1:1845 LOCKEWAY DR
Practice Address - Street 2:SUITE 404
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-5928
Practice Address - Country:US
Practice Address - Phone:770-343-9112
Practice Address - Fax:770-343-8911
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000799939CMedicaid
GA000799939CMedicaid
GAH96749Medicare UPIN