MEDICARE: MR. LARRY JUSTAIN SYKES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	100388	NC

General Provider Information

NPI Number	:	1003191503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY JUSTAIN SYKES PA-C

Provider Business Mailing Address
First Line	:	217 E ELM ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3021
Country	:	US
Telephone Number	:	336-228-9671
Fax Number	:	336-228-9674

Provider Business Practice Location Address
First Line	:	217 E ELM ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3021
Country	:	US
Telephone Number	:	336-228-9671
Fax Number	:	336-228-9674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2011
Last Update Date	:	11/15/2013

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