Provider Demographics
NPI:1063436160
Name:WHITE-GREEN, LATAMIA M (MD)
Entity type:Individual
Prefix:
First Name:LATAMIA
Middle Name:M
Last Name:WHITE-GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LATAMIA
Other - Middle Name:M
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-866-0930
Mailing Address - Fax:813-405-3722
Practice Address - Street 1:12410 N NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5352
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:813-865-0158
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-935692084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051523807OtherBLUE CROSS
AL051530813OtherBC FEDERAL EHBP
AL51528383OtherBCBS
AL000007535OtherBLUE CROSS
AL051523805OtherBLUE CROSS
AL1549813OtherUBH-BASIC
FL003907200Medicaid
AL051523806OtherBLUE CROSS
AL1549814OtherUBH-PLUS
AL009968085Medicaid
AL000007535OtherBLUE CROSS
AL1549813OtherUBH-BASIC
AL1549814OtherUBH-PLUS
FLDA5786 GROUPOtherMEDICARE RR
AL000007535Medicaid