Provider Demographics
NPI:1154585438
Name:GLEASON, COURTNEY NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:NICOLE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 HAWKS LN NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2283
Mailing Address - Country:US
Mailing Address - Phone:404-778-4398
Mailing Address - Fax:
Practice Address - Street 1:1968 HAWKS LN NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2283
Practice Address - Country:US
Practice Address - Phone:404-778-4398
Practice Address - Fax:404-778-7170
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN13066207X00000X
GA747342080S0010X, 207XX0005X
RIMD14915207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine