Provider Demographics
NPI:1275825648
Name:NEAL, LARRY W
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:W
Last Name:NEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 BRADFORD HICKS DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570
Mailing Address - Country:US
Mailing Address - Phone:931-510-3674
Mailing Address - Fax:
Practice Address - Street 1:4145 BRADFORD HICKS DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570
Practice Address - Country:US
Practice Address - Phone:931-510-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1523368Medicaid