Provider Demographics
NPI:1508313172
Name:HUSKEY, LATANJA JANECHO
Entity Type:Individual
Prefix:
First Name:LATANJA
Middle Name:JANECHO
Last Name:HUSKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2786 JACOB LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-4447
Mailing Address - Country:US
Mailing Address - Phone:678-437-7662
Mailing Address - Fax:
Practice Address - Street 1:2022 FAIRBURN RD STE D
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1062
Practice Address - Country:US
Practice Address - Phone:770-942-1044
Practice Address - Fax:770-942-1044
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily