Provider Demographics
NPI:1427233204
Name:LATARA DEMPS MD, LLC
Entity Type:Organization
Organization Name:LATARA DEMPS MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-557-2565
Mailing Address - Street 1:1 BALTIMORE PL NW STE 360
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2116
Mailing Address - Country:US
Mailing Address - Phone:404-815-7951
Mailing Address - Fax:
Practice Address - Street 1:1 BALTIMORE PL NW STE 360
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2116
Practice Address - Country:US
Practice Address - Phone:404-815-7951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-30
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053131208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADC6398OtherRAILROAD
GADC6398OtherRAILROAD