Provider Demographics
NPI:1447225057
Name:LATIMER, LINDA SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUSAN
Last Name:LATIMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 BUTTERMILK RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-2649
Mailing Address - Country:US
Mailing Address - Phone:423-477-2442
Mailing Address - Fax:423-477-0818
Practice Address - Street 1:343 BUTTERMILK RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-2649
Practice Address - Country:US
Practice Address - Phone:423-477-2442
Practice Address - Fax:423-477-0818
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30994207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3150149OtherBCBS
TN3854684Medicaid
TN3150149OtherBCBS
3854684Medicare ID - Type Unspecified