Provider Demographics
NPI:1447898937
Name:HOPKINS, LATRINA LORRAINE
Entity type:Individual
Prefix:
First Name:LATRINA
Middle Name:LORRAINE
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 GREAT SHOALS CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7098
Mailing Address - Country:US
Mailing Address - Phone:770-883-2035
Mailing Address - Fax:
Practice Address - Street 1:316 W PIKE ST STE 202G
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4878
Practice Address - Country:US
Practice Address - Phone:678-308-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-15
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO1304211744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACO130421OtherPROSTHETIC SPECIALIST