Provider Demographics
NPI:1902436595
Name:CHAMBERS, LATALIA Y (CNA (CN0028835244))
Entity Type:Individual
Prefix:MS
First Name:LATALIA
Middle Name:Y
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:CNA (CN0028835244)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 19TH ST SW APT B
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6323
Mailing Address - Country:US
Mailing Address - Phone:770-648-5389
Mailing Address - Fax:
Practice Address - Street 1:100 E 19TH ST SW APT B
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6323
Practice Address - Country:US
Practice Address - Phone:770-648-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028835244251C00000X, 251E00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management