Larson, Bradley J. G.

Larson, Bradley J. G. is an individual health care provider with primary practice located at 157 Clinic Ave Ste 101, Carrollton GA 30117-4413. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hematology & Oncology, which is considered as his primary health care specialty. Larson, Bradley J. G. can be contacted via phone (770) 333-2220.

Contact Information

Primary practice address
157 Clinic Ave Ste 101 Carrollton GA 30117-4413
Phone: (770) 333-2220
Fax: (678) 581-7180
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Hematology & Oncology 207RH0003X 054449 Georgia

Profile Details

NPI number 1194729582
LBN Legal business name Larson, Bradley J. G.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2005
Last updated Dec 13th, 2017 - about 7 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 1194729582 NPPES
Georgia Other 1194729582 NPI NUMBER
Georgia MEDICAID 009950455 NPI NUMBER
Georgia MEDICAID 184142314B NPI NUMBER
Georgia MEDICAID 184142314A NPI NUMBER
Georgia MEDICAID 184142314C NPI NUMBER

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