Provider Demographics
NPI:1992100267
Name:LOUIS, LATALYA (NP)
Entity type:Individual
Prefix:MRS
First Name:LATALYA
Middle Name:
Last Name:LOUIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:LATALYA
Other - Middle Name:
Other - Last Name:LOUIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1735 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-8941
Mailing Address - Country:US
Mailing Address - Phone:678-491-2817
Mailing Address - Fax:
Practice Address - Street 1:1735 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-8941
Practice Address - Country:US
Practice Address - Phone:678-491-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN142821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily