Healthcare Provider Details

I. General information

NPI: 1518698695
Provider Name (Legal Business Name): LATOYA COLLINS-BOOKER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6976 OLD CUSSETA RD BLDG 4202
FORT BENNING GA
31905-5431
US

IV. Provider business mailing address

6976 OLD CUSSETA RD BLDG 4202
FORT BENNING GA
31905-5431
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-3270
  • Fax:
Mailing address:
  • Phone: 706-544-3176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number26410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: