Provider Demographics
NPI:1235332230
Name:JAMES H. GENTRY, JR, MD
Entity type:Organization
Organization Name:JAMES H. GENTRY, JR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:205-373-2229
Mailing Address - Street 1:1400 CARROLLTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:ALICEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35442-1824
Mailing Address - Country:US
Mailing Address - Phone:205-373-2229
Mailing Address - Fax:205-373-3779
Practice Address - Street 1:1400 CARROLLTON RD STE B
Practice Address - Street 2:
Practice Address - City:ALICEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35442-1824
Practice Address - Country:US
Practice Address - Phone:205-373-2229
Practice Address - Fax:205-373-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9753208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51014623OtherBLUE CROSS AND BLUE SHIEL
AL51014623OtherBLUE CROSS AND BLUE SHIEL