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Individual

LATONJA M. IVERY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M. D.

Contact information

Practice address
1001 STADIUM DRIVE, STE 104, WAKE FOREST, NC 27587
(919) 623-5939
Mailing address
10900 WORLD TRADE BLVD, RALEIGH, NC 27617
(919) 237-1337
(919) 237-1625

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2004-01519
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5900011
NC
Enumeration date
01/09/2007
Last updated
06/27/2022
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