Individual
MALLORY STEPHENS TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
9160 HIGHWAY 64 STE 105, LAKELAND, TN 38002-3011
(901) 213-0100
(901) 213-0101
Mailing address
8016 ELLIS RD, BARTLETT, TN 38133-2806
(662) 322-9442
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3352
TN
Other
Enumeration date
08/22/2017
Last updated
03/26/2020
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