Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN206267 | GA |
NPI | 1043738909 |
---|---|
Provider Name | Mrs. Latoya Katrese Buford |
First Address | Temple, GA 30179-3796 |
Second Address | Temple, GA 30179-3796 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2017 |
Last Update Date | 20/12/2021 |