Provider Demographics
NPI:1811151343
Name:KENT, DOUGLAS (PHD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
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 1:1050 CROWN POINTE PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7702
Mailing Address - Country:US
Mailing Address - Phone:404-940-8080
Mailing Address - Fax:
Practice Address - Street 1:1050 CROWN POINTE PKWY STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7702
Practice Address - Country:US
Practice Address - Phone:404-940-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004359103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical