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NPI Code Detail

MEDICARE: MRS. LATASHA LASSETER MARTIN PMHNP-BC, FNP-C

MEDICARE: MRS. LATASHA LASSETER MARTIN PMHNP-BC, FNP-C
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
1363LF0000XFamily Nurse PractitionerRN198732GA
2363LP0808XPsychiatric/Mental Health Nurse PractitionerRN198732GA

General Provider Information

NPI Number : 1497296263
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LATASHA LASSETER MARTIN PMHNP-BC, FNP-C
Provider Business Mailing Address
First Line : 3726 LAKE ENCLAVE WAY
Second Line :
City : ATLANTA
State : GA
Zip : 30349-1890
Country : US
Telephone Number : 404-273-9683
Fax Number :
Provider Business Practice Location Address
First Line : 400 TECHNOLOGY CT SE STE J
Second Line :
City : SMYRNA
State : GA
Zip : 30082-5237
Country : US
Telephone Number : 770-431-2354
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2017
Last Update Date : 07/27/2023

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Directions to “ MRS. LATASHA LASSETER MARTIN PMHNP-BC, FNP-C” Practice Location

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