Provider Demographics
NPI:1982801056
Name:KENT E LATHAM MD PC
Entity Type:Organization
Organization Name:KENT E LATHAM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-590-1032
Mailing Address - Street 1:718 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-2011
Mailing Address - Country:US
Mailing Address - Phone:865-590-1032
Mailing Address - Fax:865-590-0070
Practice Address - Street 1:718 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2011
Practice Address - Country:US
Practice Address - Phone:865-590-1032
Practice Address - Fax:865-590-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8542174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB02667Medicare UPIN