Provider Demographics
NPI:1285279810
Name:DOLLISON, LATISHA SONIA
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:SONIA
Last Name:DOLLISON
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 1:985 MOUNT ZION RD APT 15C
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2256
Mailing Address - Country:US
Mailing Address - Phone:404-784-4032
Mailing Address - Fax:
Practice Address - Street 1:985 MOUNT ZION RD APT 15C
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2256
Practice Address - Country:US
Practice Address - Phone:404-784-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker