Healthcare Provider Details

I. General information

NPI: 1861400533
Provider Name (Legal Business Name): CLIFTON A LATTING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 19TH STREET ENSLEY
BIRMINGHAM AL
35218-2049
US

IV. Provider business mailing address

1517 19TH STREET ENSLEY
BIRMINGHAM AL
35218-2049
US

V. Phone/Fax

Practice location:
  • Phone: 205-785-0055
  • Fax: 205-780-5223
Mailing address:
  • Phone: 205-785-0055
  • Fax: 205-780-5223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number8248
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: