Healthcare Provider Details

I. General information

NPI: 1750340352
Provider Name (Legal Business Name): CATHY TONER LARRIMORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4181 HOSPITAL DR NE SUITE 104
COVINGTON GA
30014-2541
US

IV. Provider business mailing address

4181 HOSPITAL DR NE SUITE 104
COVINGTON GA
30014-2541
US

V. Phone/Fax

Practice location:
  • Phone: 770-385-8954
  • Fax: 770-385-8590
Mailing address:
  • Phone: 770-385-8954
  • Fax: 770-385-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number038836
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number038836
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: