Provider Demographics
NPI:1366951741
Name:COLLIER, LATONIA MELISSA (NP)
Entity type:Individual
Prefix:
First Name:LATONIA
Middle Name:MELISSA
Last Name:COLLIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LATONIA
Other - Middle Name:MELISSA
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1271
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-8004
Mailing Address - Country:US
Mailing Address - Phone:404-642-9854
Mailing Address - Fax:
Practice Address - Street 1:1855 HUDSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5000
Practice Address - Country:US
Practice Address - Phone:404-948-3019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN206622207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine