Provider Demographics
NPI:1912310269
Name:TRAWICK, LATONIA MICHELLE (NP)
Entity type:Individual
Prefix:DR
First Name:LATONIA
Middle Name:MICHELLE
Last Name:TRAWICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:DR
Other - First Name:LATONIA
Other - Middle Name:MICHELLE
Other - Last Name:TRAWICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:1747 BOULDER WALK LN SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-3990
Mailing Address - Country:US
Mailing Address - Phone:404-423-8158
Mailing Address - Fax:
Practice Address - Street 1:1747 BOULDER WALK LN SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-3990
Practice Address - Country:US
Practice Address - Phone:404-423-8158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily