MEDICARE: BARBARA LATTIMORE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	001818	GA

General Provider Information

NPI Number	:	1033282835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA LATTIMORE PHD

Provider Business Mailing Address
First Line	:	7052 SHORE RD
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-8214
Country	:	US
Telephone Number	:	404-730-0215
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 MARTIN LUTHER KING JR DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-3536
Country	:	US
Telephone Number	:	404-730-0215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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