Individual
MS. JEAN E LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
2405 OSLER CT, MEREDYTH PROFESSIONAL PLAZA, ALBANY, GA 31707
(229) 435-1458
(229) 317-2342
Mailing address
PO BOX 70969, ALBANY, GA 31708-0969
(229) 435-1458
(229) 317-2342
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
GA4044
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
671629810B
—
GA
Enumeration date
09/26/2006
Last updated
11/04/2010
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