Most Relevant Information
Provider Data
| NPI Number: | 1003642851 |
| Provider Name: | LATRELLE W TRIPP |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/10/2024 |
| Last Updated: | 09/10/2024 |
Provider Practice Location
495 FORT HILL ST
MACON
GA
312173809
Practice Location Phone/Fax
| Phone: | 4789551251 |
| Fax: | 4786214127 |
Provider Mailing Location
531 HALL ST
MACON
GA
312173704
Provider Mailing Phone/Fax
| Phone: | 4789551251 |
| Fax: |