MEDICARE: MRS. TERESA HOLT GENTRY M.A.CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AUD003286	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649335944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA HOLT GENTRY M.A.CCC-A

Provider Business Mailing Address
First Line	:	925 N POINT PKWY
Second Line	:	STE 130
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-5210
Country	:	US
Telephone Number	:	678-206-2589
Fax Number	:	678-261-1713

Provider Business Practice Location Address
First Line	:	2365 OLD MILTON PKWY
Second Line	:	STE 300
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-2140
Country	:	US
Telephone Number	:	770-740-1860
Fax Number	:	678-347-2104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	01/27/2017

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