Provider Demographics
NPI:1073259552
Name:GOLATTE, DEANNACA LATESE (APRN)
Entity Type:Individual
Prefix:
First Name:DEANNACA
Middle Name:LATESE
Last Name:GOLATTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2866 JOHNSON FERRY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8349
Mailing Address - Country:US
Mailing Address - Phone:678-528-2123
Mailing Address - Fax:770-513-4408
Practice Address - Street 1:1035 SOUTHCREST DR STE 200
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6116
Practice Address - Country:US
Practice Address - Phone:770-716-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN253416363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology