Individual
LATRESIA FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1303 PARKER RD SE, CONYERS, GA 30094-5984
(786) 351-9340
Mailing address
4240 LINDSEY WAY, CONYERS, GA 30013-4103
(786) 351-9340
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
262012
GA
163WC1500X
Community Health Registered Nurse
262012
GA
163WH0200X
Home Health Registered Nurse
262012
GA
163WI0500X
Infusion Therapy Registered Nurse
Primary
262012
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
863208181
INSURANCE COMPANIES
GA
05
—
863208181
—
GA
Enumeration date
04/22/2021
Last updated
04/22/2021
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