Provider Demographics
NPI:1811750490
Name:MCLENDON, GABRIELLE E (NP)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:E
Last Name:MCLENDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 DURLEY LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5049
Mailing Address - Country:US
Mailing Address - Phone:678-640-5578
Mailing Address - Fax:
Practice Address - Street 1:440 ERNEST W BARRETT PKWY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4918
Practice Address - Country:US
Practice Address - Phone:770-726-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF12230695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily