=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023005923
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARRY PAUL PARWORTH D.D.S., M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2005
-----------------------------------------------------
Last Update Date | 08/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 307 S BROAD ST
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30655-2119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-345-1014
-----------------------------------------------------
Fax | 678-345-1018
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2834 CORK ST
-----------------------------------------------------
City | BRASELTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30517-1110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-989-8784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 6250
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | DN122850
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------