Healthcare Provider Details

I. General information

NPI: 1477620565
Provider Name (Legal Business Name): DEANA ELIZABETH LATHAM AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 ROSS CLARK CIR
DOTHAN AL
36301-2040
US

IV. Provider business mailing address

2800 ROSS CLARK CIR
DOTHAN AL
36301-2040
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-2211
  • Fax: 334-701-1296
Mailing address:
  • Phone: 334-793-2211
  • Fax: 334-702-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1367
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1041A
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: