Individual
ROBERTO A. LARRIVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
790 CHURCH ST NE, STE 140, MARIETTA, GA 30060-8902
(770) 425-7199
(678) 819-5538
Mailing address
5555 PEACHTREE DUNWOODY RD NE, STE 125, ATLANTA, GA 30342-1703
(404) 255-2918
(404) 255-5837
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
052983
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
956323850A
—
GA
05
—
956323850B
—
GA
Enumeration date
06/16/2005
Last updated
11/05/2009
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