Doctor Name: | DR. WILLIAM RAYBURN GENTRY |
NPI Number: | 1003839887 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | P636 |
Business Practice Address: | 1922 Exeter Rd Suite 7 Germantown, TN - 381382949 |
Business Phone Number: | 9017549688 |
Business Fax Number: | 9017548630 |
Mailing Address: | 1922 Exeter Rd, Suite 7 GERMANTOWN |
State: | TN |
Postal Code: | 381382949 |
Phone Number: | 9017549688 |
Fax Number: | 9017548630 |
NPI Enumeration Date: | 07/25/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | P636 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |