Individual
LATISHA GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
A0615004
GA
363LA2200X
Adult Health Nurse Practitioner
Primary
RN212577
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
RN212577
GA
Other
Enumeration date
09/09/2015
Last updated
03/26/2026
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