Provider Demographics
NPI:1881616050
Name:GENTRY, DARRIS ALLEN (DC)
Entity type:Individual
Prefix:
First Name:DARRIS
Middle Name:ALLEN
Last Name:GENTRY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30237-0069
Mailing Address - Country:US
Mailing Address - Phone:770-981-5577
Mailing Address - Fax:770-981-1407
Practice Address - Street 1:3203 GLENWOOD RD STE D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-3200
Practice Address - Country:US
Practice Address - Phone:404-284-1154
Practice Address - Fax:404-284-0734
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFFGMedicare ID - Type Unspecified
GAU69928Medicare UPIN
GAGRP1288Medicare ID - Type UnspecifiedGROUP NUMBER