Provider Demographics
NPI:1386168524
Name:THOMAS, LARRY
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5745
Mailing Address - Country:US
Mailing Address - Phone:256-231-1231
Mailing Address - Fax:256-231-1232
Practice Address - Street 1:701 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5745
Practice Address - Country:US
Practice Address - Phone:256-231-1231
Practice Address - Fax:256-231-1232
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF07171302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner