Provider Demographics
NPI:1174296214
Name:MINOR, LATASHA (RD, LDN)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:MINOR
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 OLD MOULTON RD SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4419
Mailing Address - Country:US
Mailing Address - Phone:205-292-9595
Mailing Address - Fax:
Practice Address - Street 1:3037 OLD MOULTON RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4419
Practice Address - Country:US
Practice Address - Phone:205-292-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL919704133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered