Provider Demographics
NPI:1720603632
Name:KENT, GINA HALL (DPH)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:HALL
Last Name:KENT
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 VALLEY FORGE DR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3468
Mailing Address - Country:US
Mailing Address - Phone:423-595-9512
Mailing Address - Fax:
Practice Address - Street 1:1740 VALLEY FORGE DR
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3468
Practice Address - Country:US
Practice Address - Phone:423-595-9512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA203411835G0303X
SC56061835G0303X
NC103601835G0303X
FL224221835G0303X
TN103251835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22422OtherFLORIDA BOARD OF PHARMACY
GA20341OtherGEORGIA BOARD OF PHARMACY
SC5606OtherSOUTH CAROLINA BOARD OF PHARMACY
TN10325OtherTENNESSEE BOARD OF PHARMACY
NC10360OtherNC BOARD OF PHARMACY