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General NPI Number Information
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NPI Number | 1669675898
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Entity Type | Organization
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Legal Business Name | WILLIAM R. GENTRY, JR., PH.D., P.C.
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1922 EXETER RD SUITE 7
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City | GERMANTOWN
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State | TN
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Zip | 38138-2949
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Country | US
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Telephone | 901-754-9688
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Fax | 901-754-8630
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Provider Business Mailing Address
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Address Line | 1922 EXETER RD SUITE 7
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City | GERMANTOWN
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State | TN
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Zip | 38138-2949
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Country | US
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Telephone | 901-754-9688
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Fax | 901-754-8630
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM R. GENTRY JR.
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Credential | PH.,D.
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Telephone | 901-754-9688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P636
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License Number State | TN
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