Doctor Name: | ANGELA S LATHAM |
NPI Number: | 1043225634 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 004297 |
Business Practice Address: | 2705 Wildwood Dr Brunswick, GA - 315204346 |
Business Phone Number: | 9122646133 |
Business Fax Number: | 9122671415 |
Mailing Address: | 2705 Wildwood Dr, BRUNSWICK |
State: | GA |
Postal Code: | 315204346 |
Phone Number: | 9122646133 |
Fax Number: | 9122671415 |
NPI Enumeration Date: | 07/30/2006 |
NPI Last Update Date: | 02/11/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 004297 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |