Healthcare Provider Details

I. General information

NPI: 1073926614
Provider Name (Legal Business Name): LATONIA MICHELLE ADAMS MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 FRANKIE LN
WHITE HALL AR
71602-2699
US

IV. Provider business mailing address

1033 OLD BURR RD
WARM SPRINGS AR
72478-9077
US

V. Phone/Fax

Practice location:
  • Phone: 870-247-2305
  • Fax:
Mailing address:
  • Phone: 870-647-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: