Healthcare Provider Details

I. General information

NPI: 1790876878
Provider Name (Legal Business Name): HARDING SONNY GENTRY JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 UNION AVE #315
MEMPHIS TN
38104-3949
US

IV. Provider business mailing address

1835 UNION AVE #315
MEMPHIS TN
38104-3949
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-1284
  • Fax: 901-726-4396
Mailing address:
  • Phone: 901-726-1284
  • Fax: 901-726-4396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP0943
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: