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General NPI Number Information
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NPI Number | 1366951741
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Entity Type | Individual
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Provider Name | LATONIA MELISSA COLLIER NP
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Gender | Female
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 1855 HUDSON BRIDGE RD
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5000
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Country | US
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Telephone | 404-948-3019
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1271
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City | FAIRBURN
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State | GA
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Zip | 30213-8004
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Country | US
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Telephone | 404-642-9854
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | RN206622
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN206622
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License Number State | GA
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