Healthcare Provider Details

I. General information

NPI: 1942749783
Provider Name (Legal Business Name): LATASHA WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WHITEHAVEN RD
SAVANNAH GA
31407-4809
US

IV. Provider business mailing address

104 WHITEHAVEN RD
SAVANNAH GA
31407-4809
US

V. Phone/Fax

Practice location:
  • Phone: 912-677-2533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCO121589
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCOL001713
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: