Healthcare Provider Details

I. General information

NPI: 1912637190
Provider Name (Legal Business Name): SHEILA LARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 06/12/2022
Certification Date: 06/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 MERCY BLVD
SAVANNAH GA
31419-1711
US

IV. Provider business mailing address

3 WALLABY WAY
SAVANNAH GA
31405-9530
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-4100
  • Fax:
Mailing address:
  • Phone: 912-547-1734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number7800
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: