Healthcare Provider Details

I. General information

NPI: 1700308178
Provider Name (Legal Business Name): SANTOSHI LATTUPALLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 STUARD ST
GAFFNEY SC
29341-1263
US

IV. Provider business mailing address

PO BOX 277723
ATLANTA GA
30384-3070
US

V. Phone/Fax

Practice location:
  • Phone: 864-514-1080
  • Fax: 864-514-1090
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number84705
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: