Provider Demographics
NPI:1740527613
Name:LATIMORE, JEANETTE (RPH)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:LATIMORE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 VETERANS MEMORIAL HWY SE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-7707
Mailing Address - Country:US
Mailing Address - Phone:678-398-3657
Mailing Address - Fax:678-398-3662
Practice Address - Street 1:1025 VETERANS MEMORIAL HWY SE
Practice Address - Street 2:SUITE 400
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-7707
Practice Address - Country:US
Practice Address - Phone:678-398-3657
Practice Address - Fax:678-398-3662
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist