Individual
MRS. ANGELA LEANNE TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
4147 STRAIGHT GUT RD, LA FAYETTE, GA 30728-6749
(706) 764-2951
(706) 764-2951
Mailing address
4147 STRAIGHT GUT RD, LA FAYETTE, GA 30728-6749
(706) 764-2951
(706) 764-2951
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT002912
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00740275B
—
GA
01
—
10052428
AMERIGROUP
—
01
—
339895
WELLCARE
—
01
—
4109529
BCBS TN
—
Enumeration date
12/04/2006
Last updated
07/08/2007
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