Provider Demographics
NPI:1295295848
Name:HOGUE, LATRICE M (MD)
Entity type:Individual
Prefix:
First Name:LATRICE
Middle Name:M
Last Name:HOGUE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 MULKEY RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1112
Mailing Address - Country:US
Mailing Address - Phone:770-732-1137
Mailing Address - Fax:770-732-2081
Practice Address - Street 1:1550 MULKEY RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1112
Practice Address - Country:US
Practice Address - Phone:770-732-1137
Practice Address - Fax:770-732-2081
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-01673207N00000X, 207NS0135X
390200000X
GA97905207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program