Provider Demographics
NPI:1396183612
Name:MCNAIR, LATONYA FAYE (RN, CCM)
Entity Type:Individual
Prefix:MRS
First Name:LATONYA
Middle Name:FAYE
Last Name:MCNAIR
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 CHEYENNE TRL
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5138
Mailing Address - Country:US
Mailing Address - Phone:906-799-6510
Mailing Address - Fax:706-504-4009
Practice Address - Street 1:3957 CHEYENNE TRL
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5138
Practice Address - Country:US
Practice Address - Phone:906-799-6510
Practice Address - Fax:706-504-4009
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-08
Last Update Date:2013-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102155171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator