Provider Demographics
NPI:1811282015
Name:GATTIS, LATEESHA
Entity type:Individual
Prefix:
First Name:LATEESHA
Middle Name:
Last Name:GATTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 CARL D SILVER PKWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4960
Mailing Address - Country:US
Mailing Address - Phone:703-586-6133
Mailing Address - Fax:703-586-6846
Practice Address - Street 1:1800 CARL D SILVER PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4960
Practice Address - Country:US
Practice Address - Phone:540-786-2197
Practice Address - Fax:540-786-2350
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist