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General NPI Number Information
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NPI Number | 1477612414
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Entity Type | Organization
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Legal Business Name | LARRY W ANDERSON, DO, LLC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 6002 HIGHWAY 53 E
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City | DAWSONVILLE
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State | GA
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Zip | 30534-6227
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Country | US
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Telephone | 706-265-1335
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Fax | 706-265-2296
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Provider Business Mailing Address
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Address Line | 6002 HIGHWAY 53 E
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City | DAWSONVILLE
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State | GA
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Zip | 30534-6227
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Country | US
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Telephone | 706-265-1335
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Fax | 706-265-2296
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. LARRY W ANDERSON
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Credential | DO
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Telephone | 706-265-1335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 020648
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License Number State | GA
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