Healthcare Provider Details

I. General information

NPI: 1003190455
Provider Name (Legal Business Name): LATOYA PULLIAM BEXLEY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 DIXIE ST
CARROLLTON GA
30117-4408
US

IV. Provider business mailing address

122 ZACHARY DR
CARROLLTON GA
30117-8608
US

V. Phone/Fax

Practice location:
  • Phone: 678-796-0681
  • Fax: 770-836-8477
Mailing address:
  • Phone: 404-578-9753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP159472
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: