# LARRY R. HART, M.D., L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790830578
- **Authorized official:** LARRY R. HART M.D. (OWNER)
- **Authorized official phone:** (706) 283-1914

## Contact information

- **Practice address:** 41 CHESTNUT ST, ELBERTON, GA 30635-1805
- **Practice address phone:** (706) 283-1914
- **Practice address fax:** (706) 283-1569
- **Mailing address:** 41 CHESTNUT ST, ELBERTON, GA 30635-1805
- **Mailing address phone:** (706) 283-1914
- **Mailing address fax:** (706) 283-1569

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 023060 | GA | Yes |

## Other

- **Enumeration date:** 01/24/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 197506 | BCBS PROVIDER NUMBER | GA |
| 01 | — | GRP6319 | MEDICARE GROUP NUMBER | GA |