Provider Demographics
NPI:1588440812
Name:GENTRY, STANLEY RAY
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:RAY
Last Name:GENTRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 CREW ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-1541
Mailing Address - Country:US
Mailing Address - Phone:770-301-4061
Mailing Address - Fax:
Practice Address - Street 1:850 KENNESAW AVE NW STE 4
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1095
Practice Address - Country:US
Practice Address - Phone:714-482-5472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor