Provider Demographics
NPI:1760059281
Name:LATHAM, TOBY DAVID-CORTEZ'
Entity Type:Individual
Prefix:MR
First Name:TOBY
Middle Name:DAVID-CORTEZ'
Last Name:LATHAM
Suffix:
Gender:M
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 620
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39060-0620
Mailing Address - Country:US
Mailing Address - Phone:601-259-9750
Mailing Address - Fax:
Practice Address - Street 1:213 CASA URBANO DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5933
Practice Address - Country:US
Practice Address - Phone:601-259-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health