Provider Demographics
NPI:1447491626
Name:BROWNTEASLEY, LATONYA SHADELLA (CERTIFIED NURSES AS)
Entity type:Individual
Prefix:MRS
First Name:LATONYA
Middle Name:SHADELLA
Last Name:BROWNTEASLEY
Suffix:
Gender:F
Credentials:CERTIFIED NURSES AS
Other - Prefix:
Other - First Name:LATONYA
Other - Middle Name:SHADELLA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED NURSES ASS
Mailing Address - Street 1:3230 CUSHMAN CIRCLE
Mailing Address - Street 2:APT H-22
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-1930
Mailing Address - Country:US
Mailing Address - Phone:678-933-9875
Mailing Address - Fax:
Practice Address - Street 1:3230 CUSHMAN CIRCLE
Practice Address - Street 2:APT. H-22
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1930
Practice Address - Country:US
Practice Address - Phone:678-933-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000063548376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide