Provider Demographics
NPI:1376102780
Name:PASSMORE, LATONIA ADAMS DAVIS (RN)
Entity Type:Individual
Prefix:
First Name:LATONIA ADAMS
Middle Name:DAVIS
Last Name:PASSMORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5054
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010-5054
Mailing Address - Country:US
Mailing Address - Phone:313-282-4411
Mailing Address - Fax:
Practice Address - Street 1:100 HEADS AVE
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3616
Practice Address - Country:US
Practice Address - Phone:229-931-2494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN279226163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty