Basic Information
| Provider Information | |||||||||
| NPI: | 1093914475 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LATCH | ||||||||
| FirstName: | CLAUDIA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3686 WHEELER RD | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309096520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7069226300 | ||||||||
| FaxNumber: | 7069226303 | ||||||||
| Practice Location | |||||||||
| Address1: | 3686 WHEELER RD | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309096520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7069226300 | ||||||||
| FaxNumber: | 7069226303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2007 | ||||||||
| LastUpdateDate: | 03/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 005117 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1077177 | 01 | GA | NCCPA | OTHER | 407631325B | 05 | GA | MEDICAID | ML1721489 | 01 | GA | DEA | OTHER | 005117 | 01 | GA | GEORGIA MEDICAL LICENSE | OTHER | 407631325A | 05 | GA | MEDICAID |