Healthcare Provider Details

I. General information

NPI: 1699987131
Provider Name (Legal Business Name): JOHN GENTRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VEAZEY DR
BUTNER NC
27509-1668
US

IV. Provider business mailing address

300 VEAZEY DR
BUTNER NC
27509-1668
US

V. Phone/Fax

Practice location:
  • Phone: 919-764-2231
  • Fax:
Mailing address:
  • Phone: 919-764-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2008-00773
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: