Provider Demographics
NPI:1801867577
Name:GENTRY, CARLA FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:FRANKLIN
Last Name:GENTRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:5229 HIGHWAY 221
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-3305
Practice Address - Country:US
Practice Address - Phone:864-576-8193
Practice Address - Fax:864-576-8952
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC13423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC688786084OtherMEDICARE PIN
SC134232Medicaid
SC8688Medicare PIN
SC5878670026Medicare NSC