| Larc | |
|
1646 E Park Ave Valdosta GA 31602-3413 | |
| (229) 244-8290 | |
| (229) 244-3458 |
| Full Name | Larc |
|---|---|
| Speciality | Psychologist - Intellectual & Developmental Disabilities |
| Location | 1646 E Park Ave, Valdosta, Georgia |
| Authorized Official Name and Position | Harry A Hamm (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2292448290 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Larc 1646 E Park Ave Valdosta GA 31602-3413 Ph: (229) 244-8290 | Larc 1646 E Park Ave Valdosta GA 31602-3413 Ph: (229) 244-8290 |
| NPI Number | 1437290855 |
|---|---|
| Provider Enumeration Date | 02/09/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437290855 | NPI | - | NPPES |
| 0003946955 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TM1800X | Psychologist - Intellectual & Developmental Disabilities | (* (Not Available)) | Primary |
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