Provider Demographics
NPI:1841387776
Name:WATFORD, LATEEFAH KIBIBI ASYBI (MD)
Entity Type:Individual
Prefix:
First Name:LATEEFAH
Middle Name:KIBIBI ASYBI
Last Name:WATFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LATEEFAH
Other - Middle Name:WATFORD
Other - Last Name:GOINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:678-264-1584
Practice Address - Street 1:2400 MT. ZION PARKWAY
Practice Address - Street 2:KAISER PERMANENTE SOUTHWOOD MEDICAL CENTER
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-603-3632
Practice Address - Fax:678-264-1584
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056502208000000X, 2084F0202X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA778679783EMedicaid