Provider Demographics
NPI:1932153491
Name:ENTREKIN, KAY S (MD)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:S
Last Name:ENTREKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 COMMERCE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2627
Mailing Address - Country:US
Mailing Address - Phone:404-294-0472
Mailing Address - Fax:404-294-1558
Practice Address - Street 1:755 COMMERCE DR STE 301
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2627
Practice Address - Country:US
Practice Address - Phone:404-294-0472
Practice Address - Fax:404-294-1558
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042817207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA160046628OtherRAILROAD MEDICARE
GA000759613FMedicaid
GA618183OtherBLUE CROSS BLUE SHIELD
GA0700351OtherUNITED HEALTHCARE
GA0836556OtherAETNA/USHC
GA000759613EMedicaid
GA0700351OtherUNITED HEALTHCARE