# LARRY J GENTRY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1538113840
- **Gender:** Man
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 001373 | GA | Yes |
| 363AM0700X | Medical Physician Assistant | 001373 | GA | — |

## Other

- **Enumeration date:** 05/20/2006
- **Last updated:** 11/13/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100002611 | — | GA |
| 05 | — | 100002611A | — | GA |
| 05 | — | 100002611B | — | GA |
| 01 | — | 10041973 | AMERIGROUP | GA |
| 01 | — | 333479 | WELLCARE | GA |