Provider Demographics
NPI:1568513869
Name:LATHAM, CASSANDRA COE (NP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:COE
Last Name:LATHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222-A SHRINE ROAD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4357
Mailing Address - Country:US
Mailing Address - Phone:912-264-6303
Mailing Address - Fax:912-264-6323
Practice Address - Street 1:3222-A SHRINE ROAD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4357
Practice Address - Country:US
Practice Address - Phone:912-264-6303
Practice Address - Fax:912-264-6323
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN115534NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health