Provider Demographics
NPI:1669675898
Name:WILLIAM R. GENTRY, JR., PH.D., P.C.
Entity Type:Organization
Organization Name:WILLIAM R. GENTRY, JR., PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PH,D
Authorized Official - Phone:901-754-9688
Mailing Address - Street 1:1922 EXETER RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2949
Mailing Address - Country:US
Mailing Address - Phone:901-754-9688
Mailing Address - Fax:901-754-8630
Practice Address - Street 1:1922 EXETER RD
Practice Address - Street 2:SUITE 7
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2949
Practice Address - Country:US
Practice Address - Phone:901-754-9688
Practice Address - Fax:901-754-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP636103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3684912Medicaid
TN3984947Medicaid
TN3984947Medicare ID - Type UnspecifiedPSYCHOLOGIST-GROUP
TN3684912Medicaid