Healthcare Provider Details

I. General information

NPI: 1609209212
Provider Name (Legal Business Name): CELIA LATTIMORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 SLAB LANDING RD.
COPE SC
29038
US

IV. Provider business mailing address

6030 SLAB LANDING RD.
COPE SC
29038
US

V. Phone/Fax

Practice location:
  • Phone: 803-534-8081
  • Fax: 803-531-5614
Mailing address:
  • Phone: 803-534-8081
  • Fax: 803-531-5614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number24729
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: