Provider Demographics
NPI:1003846049
Name:MABINE, LARRY TUFANI (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:TUFANI
Last Name:MABINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7914 HIGHWAY 92
Mailing Address - Street 2:STE 130
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5238
Mailing Address - Country:US
Mailing Address - Phone:770-924-8438
Mailing Address - Fax:770-924-8431
Practice Address - Street 1:7914 HIGHWAY 92
Practice Address - Street 2:STE 130
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5238
Practice Address - Country:US
Practice Address - Phone:770-924-8438
Practice Address - Fax:770-924-8431
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053994207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology