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NPI Code Detail

MEDICARE: MS. DAWN ANGELIQUE LATTIMORE RN

MEDICARE: MS. DAWN ANGELIQUE LATTIMORE RN
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
1163W00000XRegistered NurseRN143863GA

General Provider Information

NPI Number : 1912982356
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DAWN ANGELIQUE LATTIMORE RN
Provider Business Mailing Address
First Line : 630 CHICKAMAUGA DR
Second Line :
City : MACON
State : GA
Zip : 31220-2824
Country : US
Telephone Number : 478-405-6240
Fax Number : 478-275-6645
Provider Business Practice Location Address
First Line : 2121A BELLEVUE RD
Second Line :
City : DUBLIN
State : GA
Zip : 31021-2998
Country : US
Telephone Number : 478-272-1190
Fax Number : 478-275-6509
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2005
Last Update Date : 07/08/2007

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