Provider Demographics
NPI:1639237696
Name:KENT, DONALD CARL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CARL
Last Name:KENT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000302103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
086289OtherMHN
GA002511OtherDISABILITY ADJUDICATION
4603336OtherAETNA
63576440OtherUNITED BEHAVIORAL HEALTH
A026700OtherVALUE OPTIONS
GA002511OtherDISABILITY ADJUDICATION