Provider Demographics
NPI:1205490646
Name:SANDIDGE, LATASHA QUIAUNA (RN)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:QUIAUNA
Last Name:SANDIDGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 GOLF LINK DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3714
Mailing Address - Country:US
Mailing Address - Phone:765-532-4913
Mailing Address - Fax:
Practice Address - Street 1:1514 GOLF LINK DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-3714
Practice Address - Country:US
Practice Address - Phone:765-532-4913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula