Provider Demographics
NPI:1790876878
Name:GENTRY, HARDING SONNY JR (PHD)
Entity Type:Individual
Prefix:MR
First Name:HARDING
Middle Name:SONNY
Last Name:GENTRY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1835 UNION AVE
Mailing Address - Street 2:#315
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3949
Mailing Address - Country:US
Mailing Address - Phone:901-726-1284
Mailing Address - Fax:901-726-4396
Practice Address - Street 1:1835 UNION AVE
Practice Address - Street 2:#315
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3949
Practice Address - Country:US
Practice Address - Phone:901-726-1284
Practice Address - Fax:901-726-4396
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNP0943103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3682984Medicare ID - Type Unspecified