Provider Demographics
NPI:1427151331
Name:OLSON, LARRY WAYNE (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:WAYNE
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:GA
Mailing Address - Zip Code:31811-4022
Mailing Address - Country:US
Mailing Address - Phone:706-324-1012
Mailing Address - Fax:
Practice Address - Street 1:1310 13TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2335
Practice Address - Country:US
Practice Address - Phone:706-257-7217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA394262084P0800X
KY209122084P0800X
MN245032084P0800X
NC296372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry