Individual
LATHAN WYATT OVERSTREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3355 CASCADE RD SW, ATLANTA, GA 30311-3618
(404) 699-7096
(404) 699-9933
Mailing address
PO BOX 42827, ATLANTA, GA 30311-0827
(404) 699-7096
(404) 699-9933
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036659
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00646665C
—
GA
Enumeration date
12/08/2006
Last updated
06/13/2008
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