Provider Demographics
NPI:1093914475
Name:LATCH, CLAUDIA B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:B
Last Name:LATCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6520
Mailing Address - Country:US
Mailing Address - Phone:706-922-6300
Mailing Address - Fax:706-922-6303
Practice Address - Street 1:3686 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6520
Practice Address - Country:US
Practice Address - Phone:706-922-6300
Practice Address - Fax:706-922-6303
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005117363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1077177OtherNCCPA
GA407631325BMedicaid
GA005117OtherGEORGIA MEDICAL LICENSE
GA407631325AMedicaid
GA407631325AMedicaid
GAML1721489OtherDEA