Provider Demographics
NPI:1942211537
Name:EASOM-ADAMS, LATRELLE (RRT, RCP-IV)
Entity Type:Individual
Prefix:
First Name:LATRELLE
Middle Name:
Last Name:EASOM-ADAMS
Suffix:
Gender:F
Credentials:RRT, RCP-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 HIGHWAY 84 EAST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792
Mailing Address - Country:US
Mailing Address - Phone:229-377-0251
Mailing Address - Fax:229-377-7953
Practice Address - Street 1:1155 5TH ST SE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-3142
Practice Address - Country:US
Practice Address - Phone:229-377-0251
Practice Address - Fax:229-377-7953
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001940227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered