Individual provider · Type 1 NPI
Greggory Theotis Kent, SFIDC
Military Health Care Provider · Lyons, GA
NPI number
1700425568
Active
Practice location
223 E Grady Ave
Lyons, GA 30436-1509
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Military Health Care Provider Primary | 171000000X | None listed |
Military Health Care Provider: Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
About NPI 1700425568
Greggory Theotis Kent, SFIDC's National Provider Identifier is 1700425568, issued on Dec 26, 2019. The primary taxonomy on file is Military Health Care Provider (171000000X), and the practice location is in Lyons, GA. The record was last updated on Dec 26, 2019.