Individual
LATASHA DUBOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2930 BLUFF WINDS PL, DOUGLASVILLE, GA 30135-8683
(678) 695-3734
Mailing address
8491 HOSPITAL DR, DOUGLASVILLE, GA 30134-2412
(678) 695-3734
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN094202
GA
Other
Enumeration date
07/29/2017
Last updated
07/29/2017
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