Provider Demographics
NPI:1275164550
Name:PRESTON, LATOYA (CDM,CFPP)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:PRESTON
Suffix:
Gender:F
Credentials:CDM,CFPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 HUGH HOWELL RD # B-218
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4918
Mailing Address - Country:US
Mailing Address - Phone:404-468-5972
Mailing Address - Fax:
Practice Address - Street 1:4426 HUGH HOWELL RD # B-218
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4918
Practice Address - Country:US
Practice Address - Phone:404-468-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist