Provider Demographics
NPI:1477923936
Name:CLARK-CHALMERS, LATONIA
Entity Type:Individual
Prefix:
First Name:LATONIA
Middle Name:
Last Name:CLARK-CHALMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATONIA
Other - Middle Name:CLARK
Other - Last Name:CHALMERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1601 BRENNER AVE
Mailing Address - Street 2:SALISBURY VA MEDICAL CENTER (659)
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2515
Mailing Address - Country:US
Mailing Address - Phone:704-638-9000
Mailing Address - Fax:704-638-3438
Practice Address - Street 1:1601 BRENNER AVE
Practice Address - Street 2:SALISBURY VA MEDICAL CENTER (659)
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2515
Practice Address - Country:US
Practice Address - Phone:704-638-9000
Practice Address - Fax:704-638-3438
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123456789363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health