Provider Demographics
NPI:1033474184
Name:ATWELL-SMALL, LATAURA (MD)
Entity Type:Individual
Prefix:DR
First Name:LATAURA
Middle Name:
Last Name:ATWELL-SMALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BILL CARRUTH PKWY STE 2200
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-3827
Mailing Address - Country:US
Mailing Address - Phone:470-956-4250
Mailing Address - Fax:770-999-2761
Practice Address - Street 1:144 BILL CARRUTH PKWY STE 2200
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3827
Practice Address - Country:US
Practice Address - Phone:470-956-4250
Practice Address - Fax:770-999-2761
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111325207Q00000X
GA96679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006339100Medicaid
FLGI532ZMedicare PIN