Provider Demographics
NPI:1063005767
Name:DALTON, LATRICIA A
Entity Type:Individual
Prefix:
First Name:LATRICIA
Middle Name:A
Last Name:DALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 FLINTLOCK PL
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2707
Mailing Address - Country:US
Mailing Address - Phone:678-778-3510
Mailing Address - Fax:
Practice Address - Street 1:2726 FLINTLOCK PL
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2707
Practice Address - Country:US
Practice Address - Phone:678-778-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health