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General NPI Number Information
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NPI Number | 1457750432
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Entity Type | Individual
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Provider Name | LATASHA DEVONNE JEFFERSON FNP
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Gender | Female
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 2480 WINDY HILL RD SE STE 405
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City | MARIETTA
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State | GA
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Zip | 30067-8658
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Country | US
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Telephone | 800-640-3451
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Fax |
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Provider Business Mailing Address
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Address Line | 885 HWY 138 E
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7733
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Country | US
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Telephone | 470-377-2552
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Fax | 770-385-9401
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-NP195618
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License Number State | GA
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