Provider Demographics
NPI:1447597190
Name:JONES, LARRY K
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:K
Last Name:JONES
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 1:2715 DAWSON RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1673
Mailing Address - Country:US
Mailing Address - Phone:229-431-2890
Mailing Address - Fax:229-431-2304
Practice Address - Street 1:2715 DAWSON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-1673
Practice Address - Country:US
Practice Address - Phone:229-431-2890
Practice Address - Fax:229-431-2304
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist