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GREGGORY THEOTIS KENT SFIDC

>> Military Health Care Provider >> Other Service Providers

Registrant NPI Number: 1700425568

Individual Registrant:
 GREGGORY THEOTIS KENT SFIDC
Gender: M
Sole Proprietor

Location and contact information for practice:
223 E GRADY AVE  LYONS, GA 30436-1509 US
Tel: 000-000-0000  Fax: --

Contact information for business:
223 E GRADY AVE  LYONS, GA 30436-1509 US
Tel: --  Fax: --

Registration Information:
NPI: 1700425568
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y171000000XOther Service Providers
Military Health Care Provider

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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