Active NPI
Andre Gentry, CSA
- Surgery Physician
- Acworth, GA
National Provider Identifier
1164715801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 2970
- Practice address
- 217 Brookhaven CT
Acworth, GA 30102-2190 - Phone
- (770) 985-4257
- Fax
- (770) 985-4258
- NPI assigned
- May 26, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 2970 | GA | Primary |
Addresses
Primary practice location
217 Brookhaven CT
Acworth, GA 30102-2190
Mailing address
217 Brookhaven CT
Acworth, GA 30102-2190
Phone (770) 985-4257
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2970 | GA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306368000000",
"number": "1164715801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 BROOKHAVEN CT",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301022190",
"telephone_number": "770-985-4257",
"fax_number": "770-985-4258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 BROOKHAVEN CT",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301022190",
"telephone_number": "770-985-4257",
"fax_number": "770-985-4258"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENTRY",
"first_name": "ANDRE",
"credential": "CSA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-05-26",
"last_updated": "2011-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "GA",
"license": "2970",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.