Active NPI
Larry Hugh Formby, MD
- Urology Physician
- Rome, GA
National Provider Identifier
1821082124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 19043
- Practice address
- 1013 N 5TH Ave NE
Ste One
Rome, GA 30165-2664 - Phone
- (706) 295-2393
- Fax
- (706) 290-1101
- NPI assigned
- Sep 1, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 19043 | GA | Primary |
Addresses
Primary practice location
1013 N 5TH Ave NE
Ste One
Rome, GA 30165-2664
Mailing address
1013 N 5TH Ave NE
Ste One
Rome, GA 30165-2664
Phone (706) 295-2393
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00139004A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19043 | GA | MD | Urology Physician |
Interoperability endpoints
- lformby@direct.meditouchehr.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258934400000",
"number": "1821082124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1013 N 5TH AVE NE",
"address_2": "STE ONE",
"city": "ROME",
"state": "GA",
"postal_code": "301652664",
"telephone_number": "706-295-2393",
"fax_number": "706-290-1101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1013 N 5TH AVE NE",
"address_2": "STE ONE",
"city": "ROME",
"state": "GA",
"postal_code": "301652664",
"telephone_number": "706-295-2393",
"fax_number": "706-290-1101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMBY",
"first_name": "LARRY",
"middle_name": "HUGH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-01",
"last_updated": "2009-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "GA",
"license": "19043",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00139004A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rome, GA
- Floyd Physicians, LLC
- Gwynne Douglas Floyd, MD
- Cody Folsom, NP
- Foot, Ankle & Leg Center of Rome LLC
- Kristofer Ryan Foreman, P.A.
- Ebone Monique Fortenberry
- Forum Group @ Mt. Berry Nursing & Rehabilitation Center, LLC
- Forum Group at Moran Lake Nursing & Rehabilitation Center, LLC
- Quanecia N Foster
- Foundations Orthodontics LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.