Greggory Theotis Kent, SFIDC

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

Practice address

223 E Grady Ave
Lyons, GA 30436-1509

Phone

(000) 000-0000

NPI assigned

Dec 26, 2019

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• Direct secure messaging: greggory.t.kent.mil@mail.mil

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 26, 2019.

{
    "created_epoch": "1577318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577318400000",
    "number": "1700425568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 E GRADY AVE",
            "city": "LYONS",
            "state": "GA",
            "postal_code": "304361509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 E GRADY AVE",
            "city": "LYONS",
            "state": "GA",
            "postal_code": "304361509",
            "telephone_number": "000-000-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENT",
        "first_name": "GREGGORY",
        "middle_name": "THEOTIS",
        "credential": "SFIDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-12-26",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Greggory.t.kent.mil@mail.mil",
            "affiliation": "N",
            "address_1": "223 E Grady Ave",
            "city": "Lyons",
            "state": "GA",
            "country_code": "US",
            "postal_code": "304361509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Lyons, GA
• Military Health Care Provider in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.