Provider Information for 1245508993
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LATASHA MATTHEWS
Sex: Female
NPI: 1245508993
Last Updated: 2017-07-26
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1245508993 | ||||||||||||
| Enumeration Date | 2011-12-08 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 392 CLEARSPRINGS DR LAWRENCEVILLE, GA 30046-6881 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 1840 OLD NORCROSS RD STE 300 LAWRENCEVILLE, GA 30044-8803 United States Phone: 404-914-2521 | Fax: | ||||||||||||
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