Larisa Bradford LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LARISA BRADFORD LLC

Practice address

808 Main St SW
Gainesville, GA 30501-4472

Phone

(404) 808-6071

NPI assigned

Sep 6, 2024

Organization subpart

No

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

Authorized official

Name

Larisa Russell, MDNPI 1104812494

Title

Owner/Medical Doctor

Phone

(404) 808-6071

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Larisa Viktorovna Russell, M.D.

  • Family Medicine Physician
  • Birmingham, AL
  • NPI 1104812494

  GA

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1725580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1629803754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 MAIN ST SW",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305014472",
            "telephone_number": "404-808-6071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 MAIN ST SW",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305014472",
            "telephone_number": "404-808-6071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARISA BRADFORD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-06",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "LARISA",
        "authorized_official_title_or_position": "OWNER/MEDICAL DOCTOR",
        "authorized_official_telephone_number": "404-808-6071",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://providercloud.inovalon.com/",
            "affiliation": "N",
            "endpointDescription": "Clearinghouse",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "808 Main St SW",
            "city": "Gainesville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "305014472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lanier Therapy in Motion
• Lanier Treatment Center
• Lanier Urgent Care
• Lisha Annette-Kathleen Lansberry, APRN
• Jennifer Lanzer, M.D.
• Lauren Larocque, AA
• Laura Elizabeth Lasseter, LCSW
• Amy Lathem, NP
• Kelly Miller Lathem, M.D.
• Jessica Latimer, PTA

• Family Medicine Physician in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.