Provider Demographics
NPI:1760297691
Name:LATHAM, GAVIN (CBCS)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:LATHAM
Suffix:
Gender:M
Credentials:CBCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SCOTLAND DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-2631
Mailing Address - Country:US
Mailing Address - Phone:678-887-2779
Mailing Address - Fax:
Practice Address - Street 1:3672 MARATHON CIR STE 140
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6821
Practice Address - Country:US
Practice Address - Phone:470-502-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other