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Individual

MR. DAVID E LATHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1104 TUSCULUM BLVD, SUITE 114, GREENEVILLE, TN 37745-4091
(423) 639-0941
(423) 638-3401
Mailing address
PO BOX 896138, CHARLOTTE, NC 28289-6138
(423) 639-0941
(423) 638-3401

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
8864
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
RN0000039907
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3052082
BC/BS, BLUECARE, TENNCARE
TN
05
3603521
TN
Enumeration date
03/17/2006
Last updated
09/15/2014
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