Individual
ASHLEY LAUREN TATHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
3407 SHAMROCK CT, GAUTIER, MS 39553-5337
(601) 947-4274
Mailing address
3407 SHAMROCK CT, GAUTIER, MS 39553-5337
(601) 947-4274
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018214
—
MS
Enumeration date
11/13/2019
Last updated
11/13/2019
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