Individual
TOMMY LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSFA
Contact information
Practice address
266 S VILLAGE SQ, CANTON, GA 30115-1861
(770) 851-3123
Mailing address
266 S VILLAGE SQ, CANTON, GA 30115-1861
(770) 851-3123
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
06/11/2017
Last updated
07/22/2021
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