Provider Demographics
NPI:1215648209
Name:FUNCHES, LATESHA
Entity type:Individual
Prefix:
First Name:LATESHA
Middle Name:
Last Name:FUNCHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 ALLMAN DR
Mailing Address - Street 2:JONESBORO, GA
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236
Mailing Address - Country:US
Mailing Address - Phone:404-645-6361
Mailing Address - Fax:
Practice Address - Street 1:2238 ALLMAN DR
Practice Address - Street 2:JONESBORO, GA
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:404-645-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula