Provider Demographics
NPI:1750709192
Name:GENTRY, JACQUELINE CAROL (MD)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:CAROL
Last Name:GENTRY
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 1:1949 GUNBARREL ROAD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-495-4345
Mailing Address - Fax:423-495-4934
Practice Address - Street 1:1720 GUNBARREL ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-648-8110
Practice Address - Fax:423-443-4297
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine