Individual
DR. LATANIA K. LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., MSPH
Contact information
Practice address
1400 TULLIE RD NE, ATLANTA, GA 30329-2309
(404) 785-5437
Mailing address
1725 W HARRISON ST, STE 710, CHICAGO, IL 60612-3841
(312) 942-6396
(312) 942-4168
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036-113313
IL
2080P0208X
Pediatric Infectious Diseases Physician
036-113313
IL
2080P0208X
Pediatric Infectious Diseases Physician
Primary
92099
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-113313
STATE LICENSE NUMBER
IL
01
—
336-074676
STATE LICENSE, CONTROLLED SUBSTANCE
IL
01
—
92099
STATE LICENSE NUMBER
GA
Enumeration date
08/14/2008
Last updated
06/29/2022
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