Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 053994 | GA |
NPI | 1003846049 |
---|---|
Provider Name | Larry Tufani Mabine |
First Address | Woodstock, GA 30189-5238 |
Second Address | Woodstock, GA 30189-5238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 21/11/2013 |