Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | P636 | TN |
Y | 103TC0700X | Clinical Psychologist | P636 | TN |
NPI | 1003839887 |
---|---|
Provider Name | Dr. William Rayburn Gentry JR. |
First Address | Germantown, TN 38138-2949 |
Second Address | Germantown, TN 38138-2949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3684912 | (05) | TN |
3984947 | (05) | TN |