Individual
LATASHA A GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25 KALIN ST, PHENIX CITY, AL 36869-3469
(706) 330-3754
Mailing address
25 KALIN ST, PHENIX CITY, AL 36869-3469
(706) 330-3754
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/11/2019
Last updated
03/11/2019
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