Individual
LARRY HUGH FORMBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1013 N 5TH AVE NE, STE ONE, ROME, GA 30165-2664
(706) 295-2393
(706) 290-1101
Mailing address
1013 N 5TH AVE NE, STE ONE, ROME, GA 30165-2664
(706) 295-2393
(706) 290-1101
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
19043
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00139004A
—
GA
Enumeration date
09/01/2005
Last updated
11/23/2009
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