Provider Demographics
NPI:1538244678
Name:LATHAM, MARION STEVENS (PHD)
Entity type:Individual
Prefix:DR
First Name:MARION
Middle Name:STEVENS
Last Name:LATHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2801 BUFORD HWY NE
Mailing Address - Street 2:550B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2149
Mailing Address - Country:US
Mailing Address - Phone:404-636-9402
Mailing Address - Fax:404-636-9592
Practice Address - Street 1:2801 BUFORD HWY NE
Practice Address - Street 2:550B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2149
Practice Address - Country:US
Practice Address - Phone:404-636-9402
Practice Address - Fax:404-636-9592
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical