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Greggory Theotis Kent, SFIDC
Military Health Care Provider in Lyons, Georgia
NPI 1700425568

Greggory Theotis Kent is a Military Health Care Provider based in Lyons, GA. Greggory Theotis Kent practices in Lyons, GA and has the professional credentials of SFIDC. The NPI Number for Greggory Theotis Kent is 1700425568 and holds a License No. (Georgia).

The current practice location address for Greggory Theotis Kent is 223 E Grady Ave, Lyons, GA and can be reached out via phone at 000-000-0000.

Location: 223 E Grady Ave, Lyons, GA, 30436-1509
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1700425568
Provider Name
Greggory Theotis Kent
Credential
SFIDC
Provider Entity Type
Individual
Gender
Male
Address
223 E Grady Ave, Lyons, GA, 30436-1509
Phone Number
000-000-0000
Fax Number
Provider Enumeration Date
12/26/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
223 E Grady Ave
City
Lyons
State
Georgia
Zip
30436-1509
Phone Number
000-000-0000
Fax Number
person
Provider Business Mailing Address Details
Address
223 E Grady Ave
City
Lyons
State
Georgia
Zip
30436-1509
Phone Number
000-000-0000
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
171000000X
License No.
()
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
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