Provider Demographics
NPI:1659717569
Name:PERKINS, LATRENDA S (DO)
Entity Type:Individual
Prefix:
First Name:LATRENDA
Middle Name:S
Last Name:PERKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 VERNON RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4131
Mailing Address - Country:US
Mailing Address - Phone:706-812-2369
Mailing Address - Fax:706-845-3194
Practice Address - Street 1:61 ROBINSON LAKE RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6275
Practice Address - Country:US
Practice Address - Phone:678-633-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-18
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA76650204R00000X, 207R00000X
PAOTO15170207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine