Individual
DR. LARISA P GAVRILOVA-JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 724-6100
Mailing address
1499 WALTON WAY, SUITE 1400, AUGUSTA, GA 30901-2603
(706) 724-6100
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
2006-00745
NC
207V00000X
Obstetrics & Gynecology Physician
46727
MN
207VE0102X
Reproductive Endocrinology Physician
Primary
70748
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5909224
—
NC
05
—
891448600
—
MN
Enumeration date
01/11/2006
Last updated
06/24/2019
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