Individual
EVA LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1350 WALTON WAY, AUGUSTA, GA 30901-2612
(706) 774-2176
Mailing address
5665 NEW NORTHSIDE DR NW, SUITE 320, ATLANTA, GA 30328-5831
(770) 874-5400
(770) 874-5469
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005093
GA
Other
Enumeration date
09/15/2008
Last updated
09/15/2008
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