=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841575354
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LATOYA WINSTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2011
-----------------------------------------------------
Last Update Date | 10/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3253 DIAMOND BLF
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30291
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-914-0276
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3253 DIAMOND BLF
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30291
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-914-0276
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CNA
-----------------------------------------------------
Name | LATOYA WINSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-457-1637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3140N1450X
-----------------------------------------------------
Taxonomy Name | Nursing Care, Pediatric
-----------------------------------------------------
License Number | CN0030004172
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------