Provider Demographics
NPI:1457019648
Name:ANTHONY, LATEEKA (CNA)
Entity Type:Individual
Prefix:
First Name:LATEEKA
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 HAMMOND CT
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-3957
Mailing Address - Country:US
Mailing Address - Phone:678-334-9257
Mailing Address - Fax:
Practice Address - Street 1:2261 HAMMOND CT
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-3957
Practice Address - Country:US
Practice Address - Phone:678-334-9257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty