Provider Demographics
NPI:1093968984
Name:DR. JOAN KENT OR DR. DONALD KENT
Entity Type:Organization
Organization Name:DR. JOAN KENT OR DR. DONALD KENT
Other - Org Name:DRS JOAN OR DONALD KENT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-321-6322
Mailing Address - Street 1:2531 BRIARCLIFF RD NE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3017
Mailing Address - Country:US
Mailing Address - Phone:404-321-6322
Mailing Address - Fax:
Practice Address - Street 1:2531 BRIARCLIFF RD NE
Practice Address - Street 2:SUITE 111
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3017
Practice Address - Country:US
Practice Address - Phone:404-321-6322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343103T00000X
GA302103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1366500324OtherCAHABA CMS
GA1093968984OtherCMS CAHABA
GA1639237696OtherCAHABA CMS