Gavrilova-Jordan, Larisa P

Gavrilova-Jordan, Larisa P is an individual health care provider with primary practice located at 1120 15Th St , Augusta GA 30912-0004. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Reproductive Endocrinology, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology. Allopathic & Osteopathic Physicians / Reproductive Endocrinology is her primary health care specialty. Gavrilova-Jordan, Larisa P can be contacted via phone (706) 724-6100.

Contact Information

Primary practice address
1120 15Th St Augusta GA 30912-0004
Phone: (706) 724-6100
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Reproductive Endocrinology 207VE0102X 70748 Georgia
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 46727 Minnesota
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 2006-00745 North Carolina

Profile Details

NPI number 1003895780
LBN Legal business name Gavrilova-Jordan, Larisa P
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2006
Last updated Jun 24th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003895780 NPPES
North Carolina MEDICAID 5909224
North Carolina MEDICAID 891448600

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