Individual provider Active NPI

Leo Enrique Larios, DO

  • Family Medicine Physician
  • Moultrie, GA
National Provider Identifier
1154907517
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
99713 Issued in GA
Practice address
1 Magnolia CT
Moultrie, GA 31768-6764
Phone
(229) 502-9769
NPI assigned
Mar 24, 2021
Last updated
Dec 17, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 99713 GA Primary

Addresses

Primary practice location

1 Magnolia CT
Moultrie, GA 31768-6764

Mailing address

1 Magnolia CT
Moultrie, GA 31768-6764
Phone (229) 502-9753

Other practice location 1

1201 W Peachtree St NW Ste 2300
Atlanta, GA 30309-3453
Phone (904) 586-1964

Other practice location 2

200 Perry House Rd
Fitzgerald, GA 31750-8857
Phone (229) 424-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240625000630 GA Practitioner - Family PracticePractitioner - Internal Medicine 7810430337 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DMC Physician Group LLCGroup PAC ID 8628296845, 20 clinicians
Tift Regional Health System IncGroup PAC ID 2062745169, 294 clinicians

Practice addresses (Care Compare)

200 Perry House Rd
Fitzgerald, GA 31750-8857
Phone (229) 424-7100

2225 US Hwy 41 N
Tifton, GA 31794-2749
Phone (229) 391-4100

2227 US Hwy 41 N
Tifton, GA 31794-2749
Phone (229) 353-6188

260 MJ Taylor Rd
Adel, GA 31620-3485
Phone (229) 896-8159

901 18TH St E
Tifton, GA 31794-3648
Phone (229) 382-7120

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Tift Regional Health System Inc CurrentSince Aug 1, 2024 Accepting new patients
Southland Emergency Medical Services Consolidated, LLC Family Medicine CurrentSince Jul 1, 2025 Accepting new patients
DMC Physician Group LLC Family Medicine CurrentSince Jun 1, 2024 Accepting new patients
Southland Consolidated Emergency Services, LLC CurrentSince Jul 1, 2025 Accepting new patients
Southland Cochran Emergency Medical Services, LLC CurrentSince Jul 1, 2025 Accepting new patients
Southland Bainbridge Hospitalist Group, LLC CurrentSince Jul 1, 2025 Accepting new patients
Southland Emergency Medical Services, L.L.C CurrentSince Jul 1, 2025 Accepting new patients
Tift Regional Health System Inc Family Medicine Current Accepting new patients
DMC Physician Group LLC Family Medicine CurrentSince Jun 1, 2024 Accepting new patients
Tift Regional Health System Inc. CurrentSince Aug 1, 2024 Accepting new patients
Pcos Sisters Telehealth Clinic & Wellness Center, LLC Family Medicine Past Accepting new patients
Hospital Authority of Ben Hill Past Accepting new patients

Locations

260 Mj Taylor Rd
Adel, GA 31620
Phone (229) 247-2290

1500 E Shotwell St
Bainbridge, GA 39819
Phone (229) 243-6100

90 E Stephens St
Camilla, GA 31730
Phone (229) 200-4950

145 E Peacock St
Cochran, GA 31014
Phone (229) 200-4950

4 Medical Dr
Elberton, GA 30635
Phone (706) 213-2527

182 Perry House Rd
Ste H
Fitzgerald, GA 31750
Phone (229) 423-9561

200 Perry House Rd
Fitzgerald, GA 31750
Phone (229) 424-1461

2227 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-6188

901 18th St E
Tifton, GA 31794
Phone (229) 353-6208

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1154907517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MAGNOLIA CT",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686764",
            "telephone_number": "229-502-9753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MAGNOLIA CT",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686764",
            "telephone_number": "229-502-9769"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 W Peachtree St NW Ste 2300",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303093453",
            "country_code": "US",
            "telephone_number": "904-586-1964",
            "fax_number": "888-597-2357",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Perry House Rd",
            "address_purpose": "LOCATION",
            "city": "Fitzgerald",
            "state": "GA",
            "postal_code": "317508857",
            "country_code": "US",
            "telephone_number": "229-424-7100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARIOS",
        "first_name": "LEO",
        "middle_name": "ENRIQUE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-24",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "99713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moultrie, GA

Sources for this page

Verify at the official NPI Registry.