Provider Demographics
NPI:1396525580
Name:THOMAS, LATADRA S
Entity type:Individual
Prefix:
First Name:LATADRA
Middle Name:S
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CONVENIENT CLINICAL
Other - Middle Name:
Other - Last Name:LABS LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:231 VINCENNE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3342
Mailing Address - Country:US
Mailing Address - Phone:478-299-2244
Mailing Address - Fax:
Practice Address - Street 1:231 VINCENNE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3342
Practice Address - Country:US
Practice Address - Phone:478-299-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy