Individual
LARISSA THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
190 WYNDMONT WAY, COVINGTON, GA 30014-7904
(803) 414-3510
Mailing address
PO BOX 1433, COVINGTON, GA 30015-1433
(803) 414-3510
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347E00000X
Transportation Broker
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
01/05/2021
Last updated
01/05/2021
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