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NPI Code Detail

MEDICARE: MRS. LATASHA DEVONNE JEFFERSON FNP

MEDICARE: MRS. LATASHA DEVONNE JEFFERSON FNP
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
1363LF0000XFamily Nurse PractitionerAPRN-NP195618GA

General Provider Information

NPI Number : 1457750432
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LATASHA DEVONNE JEFFERSON FNP
Provider Business Mailing Address
First Line : 885 HWY 138 E
Second Line :
City : STOCKBRIDGE
State : GA
Zip : 30281-7733
Country : US
Telephone Number : 470-377-2552
Fax Number : 770-385-9401
Provider Business Practice Location Address
First Line : 2480 WINDY HILL RD SE STE 405
Second Line :
City : MARIETTA
State : GA
Zip : 30067-8658
Country : US
Telephone Number : 800-640-3451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2014
Last Update Date : 10/21/2025

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