Provider Demographics
NPI:1538110523
Name:LATHAM, KENT EMERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:EMERSON
Last Name:LATHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KENT
Other - Middle Name:EMERSON
Other - Last Name:LATHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:718 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-2011
Mailing Address - Country:US
Mailing Address - Phone:865-590-1032
Mailing Address - Fax:865-590-0070
Practice Address - Street 1:718 MORGAN ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2011
Practice Address - Country:US
Practice Address - Phone:865-590-1032
Practice Address - Fax:865-590-0070
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB02667Medicare UPIN