Provider Demographics
NPI:1679884266
Name:DENSON, LARRY DANIEL JR
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DANIEL
Last Name:DENSON
Suffix:JR
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 1:3100 RANLO DR
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4614
Mailing Address - Country:US
Mailing Address - Phone:770-414-4812
Mailing Address - Fax:
Practice Address - Street 1:3100 RANLO DR
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-4614
Practice Address - Country:US
Practice Address - Phone:770-414-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC208080163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse