Individual
LARRY J GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1000 JOHNSON FERRY RD NE, ATLANTA, GA 30342-1606
(404) 851-8000
Mailing address
PO BOX 2968, KENNESAW, GA 30156-9117
(770) 779-0015
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001373
GA
363AM0700X
Medical Physician Assistant
001373
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002611
—
GA
05
—
100002611A
—
GA
05
—
100002611B
—
GA
01
—
10041973
AMERIGROUP
GA
01
—
333479
WELLCARE
GA
Enumeration date
05/20/2006
Last updated
11/13/2008
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