Provider Demographics
NPI:1427335504
Name:POOLE, LATOYA ICELLE (PCT)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:ICELLE
Last Name:POOLE
Suffix:
Gender:F
Credentials:PCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 SHEFFIELD LN
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-8773
Mailing Address - Country:US
Mailing Address - Phone:404-409-7280
Mailing Address - Fax:
Practice Address - Street 1:316 SHEFFIELD LN
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-8773
Practice Address - Country:US
Practice Address - Phone:404-409-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028906123374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide