Individual
DR. LATISHA MECHELE HILTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
716 SPRING STREET, SUITE 204, WISE, VA 24293
(276) 329-8910
(276) 328-4318
Mailing address
716 SPRING ST., SUITE 204, WISE, VA 24293
(276) 328-8910
(276) 328-4318
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0102202078
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528253846
—
VA
05
—
7100077100
—
KY
01
—
C10456
TRAILBLAZER
VA
01
—
P00819102
RR MEDICARE
—
Enumeration date
09/10/2007
Last updated
03/17/2015
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