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Individual

JACOB ALEXANDER LARISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
FNP-C

Contact information

Practice address
115 GENEVIEVE CT, PEACHTREE CITY, GA 30269-4803
(682) 216-9595
Mailing address
34 CHERRY TREE BND, NEWNAN, GA 30265-2602
(682) 216-9595

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN299713
GA
363LF0000X
Family Nurse Practitioner
Primary
RN299713
GA

Other

Enumeration date
04/22/2022
Last updated
01/29/2024
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