Provider Demographics
NPI:1629440607
Name:DAY, LARRY
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:DAY
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 1:111 STRATFORD ST E
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8736
Mailing Address - Country:US
Mailing Address - Phone:229-425-4295
Mailing Address - Fax:
Practice Address - Street 1:1430 US HIGHWAY 82 W
Practice Address - Street 2:SUITE 105
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-8011
Practice Address - Country:US
Practice Address - Phone:229-388-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily