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General NPI Number Information
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NPI Number | 1194155002
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Entity Type | Individual
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Provider Name | LATOSHIA ZELLNER
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Gender | Female
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 1953 OLD ATLANTA RD
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City | GRIFFIN
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State | GA
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Zip | 30223-1180
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Country | US
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Telephone | 404-955-9108
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Fax | 770-914-1690
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Provider Business Mailing Address
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Address Line | 56 CLAYTON ENGLISH DR
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City | FORSYTH
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State | GA
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Zip | 31029-9441
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Country | US
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Telephone | 478-394-1623
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Fax | 770-914-1690
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | PHCP013303
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License Number State | GA
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