Individual
GEORGIA LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
393 N MAIN ST, SPARTA, NC 28675-8896
(336) 372-7575
(336) 372-7540
Mailing address
393 N MAIN ST, P.O. BOX 1209, SPARTA, NC 28675-8896
(336) 372-7575
(336) 372-7540
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9300197
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89012PJ
—
NC
Enumeration date
08/20/2006
Last updated
07/08/2007
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