| Larisa Bradford Llc | |
|
3478 Westhampton Way Gainesville GA 30506-1063 | |
| (678) 928-9212 | |
| Not Available |
| Full Name | Larisa Bradford Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3478 Westhampton Way, Gainesville, Georgia |
| Authorized Official Name and Position | Larisa Viktrovna Russell (OWNER) |
| Authorized Official Contact | 6789289212 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Larisa Bradford Llc 3478 Westhampton Way Gainesville GA 30506-1063 Ph: (678) 928-9212 | Larisa Bradford Llc 3478 Westhampton Way Gainesville GA 30506-1063 Ph: (678) 928-9212 |
| NPI Number | 1629803754 |
|---|---|
| Provider Enumeration Date | 09/06/2024 |
| Last Update Date | 09/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629803754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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