Provider Demographics
NPI:1164234548
Name:LATTA, GERALD GERMAIN
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:GERMAIN
Last Name:LATTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 SADLER AVE
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-7830
Mailing Address - Country:US
Mailing Address - Phone:252-767-5386
Mailing Address - Fax:
Practice Address - Street 1:1979 SADLER AVE
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-7830
Practice Address - Country:US
Practice Address - Phone:252-767-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)