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General NPI Number Information
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NPI Number | 1417458498
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Entity Type | Individual
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Provider Name | LARRICE TELA GORLEY
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Gender | Female
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 1401 PEACHTREE ST NE STE 105
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City | ATLANTA
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State | GA
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Zip | 30309-3023
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Country | US
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Telephone | 470-749-3520
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Fax |
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Provider Business Mailing Address
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Address Line | 174 EMERALD POINTE DR
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City | CARROLLTON
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State | GA
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Zip | 30116-9409
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Country | US
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Telephone | 470-670-7280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN222604
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN222604
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License Number State | GA
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