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General NPI Number Information
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NPI Number | 1326322462
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Entity Type | Organization
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Legal Business Name | J B GENTRY MD PA
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 706 W KING ST
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-2708
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Country | US
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Telephone | 980-487-3151
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Fax | 980-487-3689
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Provider Business Mailing Address
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Address Line | PO BOX 577
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-0577
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Country | US
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Telephone | 980-487-3151
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Fax | 980-487-3689
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. J B GENTRY
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Credential | MD PA
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Telephone | 980-487-3151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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