Individual
LATASHA RAIFORD MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5736 N TRYON ST, CHARLOTTE, NC 28213-6850
(980) 498-6143
Mailing address
11004 DIPALI CT, CHARLOTTE, NC 28214-7664
(980) 200-7909
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
08/05/2021
Last updated
08/05/2021
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