Provider Demographics
NPI:1114511342
Name:LATHAM, EMILY CARTER (CRNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CARTER
Last Name:LATHAM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 BELTLINE RD SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-5506
Mailing Address - Country:US
Mailing Address - Phone:256-353-3500
Mailing Address - Fax:
Practice Address - Street 1:2699 SANDLIN RD SW STE B8
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-7343
Practice Address - Country:US
Practice Address - Phone:256-822-2171
Practice Address - Fax:256-822-2169
Is Sole Proprietor?:No
Enumeration Date:2021-02-28
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily