Healthcare Provider Details

I. General information

NPI: 1376543330
Provider Name (Legal Business Name): LARRY DEWAIN GUTHRIE JR. RPH, CDM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ATHENS VA OUTPATIENT CLINIC 9249 HIGHWAY 29 NORTH
ATHENS GA
30601-1400
US

IV. Provider business mailing address

1080 KNOX RDG
ATHENS GA
30606-7044
US

V. Phone/Fax

Practice location:
  • Phone: 706-227-4548
  • Fax: 706-227-4538
Mailing address:
  • Phone: 706-583-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH016103
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH016103
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: