MEDICARE: LATOYA LASHELLE SHEPHERD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1447765722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA LASHELLE SHEPHERD

Provider Business Mailing Address
First Line	:	214 N BECKMAN CT
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-0417
Country	:	US
Telephone Number	:	470-358-0737
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 N BECKMAN CT
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-0417
Country	:	US
Telephone Number	:	470-358-0737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2017
Last Update Date	:	12/07/2017

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Directions to “ LATOYA LASHELLE SHEPHERD ” Practice Location

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