Provider Demographics
NPI:1952680126
Name:TATE, LATOYA K (DPT)
Entity Type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:K
Last Name:TATE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 TREECREST PKWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-3579
Mailing Address - Country:US
Mailing Address - Phone:919-358-6642
Mailing Address - Fax:
Practice Address - Street 1:5240 SNAPFINGER PARK DR
Practice Address - Street 2:STE 130
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4059
Practice Address - Country:US
Practice Address - Phone:770-322-7003
Practice Address - Fax:770-322-7630
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010409174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist