Provider Demographics
NPI:1457583627
Name:LATIMER, EWING CRAIG IV (MS, BCBA)
Entity type:Individual
Prefix:MR
First Name:EWING
Middle Name:CRAIG
Last Name:LATIMER
Suffix:IV
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 VALLEYDALE DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-9457
Mailing Address - Country:US
Mailing Address - Phone:256-453-4261
Mailing Address - Fax:
Practice Address - Street 1:16 VALLEYDALE DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-9457
Practice Address - Country:US
Practice Address - Phone:256-453-4261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst