Provider Demographics
NPI:1518583442
Name:DAVIS, LATONIA
Entity Type:Individual
Prefix:
First Name:LATONIA
Middle Name:
Last Name:DAVIS
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:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:SMITHS STATION
Mailing Address - State:AL
Mailing Address - Zip Code:36877-0178
Mailing Address - Country:US
Mailing Address - Phone:334-614-8275
Mailing Address - Fax:
Practice Address - Street 1:1238 2ND AVE STE 6
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-5241
Practice Address - Country:US
Practice Address - Phone:334-614-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No347C00000XTransportation ServicesPrivate Vehicle