Individual
BERNICE GRANT LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
505 W LEIGH ST, SUITE 301, RICHMOND, VA 23220-3200
(804) 780-3008
(804) 780-3014
Mailing address
PO BOX 26965, RICHMOND, VA 23261-6965
(804) 780-3008
(804) 780-3014
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101023261
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5671051
—
VA
Enumeration date
08/14/2006
Last updated
12/13/2010
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