Individual
RICKY O TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
306 ISABELLA ST, WAYCROSS, GA 31501-3636
(912) 285-9990
(912) 338-8931
Mailing address
1007 MARY ST, WAYCROSS, GA 31503-3823
(912) 449-8601
(912) 449-7060
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002235
GA
Other
Enumeration date
03/26/2010
Last updated
01/08/2026
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