Organization
LARISA BRADFORD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARISA RUSSELL MD (OWNER/MEDICAL DOCTOR)
(404) 808-6071
Entity
Organization
Contact information
Practice address
808 MAIN ST SW, GAINESVILLE, GA 30501-4472
(404) 808-6071
Mailing address
808 MAIN ST SW, GAINESVILLE, GA 30501-4472
(404) 808-6071
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/06/2024
Last updated
01/23/2025
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