OrganizationLarisa Bradford LlcFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address808 Main St SW, Gainesville, GA 30501-4472(404) 808-6071PECOS EnrollmentBased on the most recent information from CMS, provider Larisa Bradford Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1629803754Provider TypeOrganizationFull NameLarisa Bradford LlcSubpartNoEnumeration Date9/6/2024Last Updated1/23/2025Contact InformationPractice LocationPractice Address808 Main St SW, Gainesville, GA 30501-4472Phone(404) 808-6071FaxUnlisted FaxMailing LocationMailing Address808 Main St SW, Gainesville, GA 30501-4472Phone(404) 808-6071FaxUnlisted FaxAuthorized OfficialNameRussell, Larisa (Owner/Medical Doctor)Phone(404) 808-6071Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted Issuer