Individual
LARRY D JEFFERSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
342 SYLVAN RD, COLUMBUS, MS 39702-3014
(662) 364-0578
Mailing address
342 SYLVAN RD, COLUMBUS, MS 39702-3014
(662) 435-5300
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
Primary
801522422
MS
Other
Enumeration date
06/16/2025
Last updated
06/23/2025
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