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Individual

LATIESHA COLISE JAMES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2529 TERRACE TRL, DECATUR, GA 30035-3514
(334) 947-7488
Mailing address
PO BOX 683, GRAY, GA 31032-0683
(678) 531-3452

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
171W00000X
GA
171W00000X
Contractor
GA

Other

Enumeration date
03/15/2019
Last updated
03/15/2019
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