Provider Demographics
NPI:1558656983
Name:BILBREW, LATTISHA LATOYAH (MD)
Entity Type:Individual
Prefix:DR
First Name:LATTISHA
Middle Name:LATOYAH
Last Name:BILBREW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LATTISHA
Other - Middle Name:LATOYA
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2166
Mailing Address - Country:US
Mailing Address - Phone:770-979-9903
Mailing Address - Fax:
Practice Address - Street 1:1600 MEDICAL WAY STE 150
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2166
Practice Address - Country:US
Practice Address - Phone:770-979-9903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10040944207X00000X
GA077665207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty