Organization
TATUM MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT E TATUM M.D. (MANAGER)
(601) 421-3454
Entity
Organization
Contact information
Practice address
5903 RIDGEWOOD RD STE 330, JACKSON, MS 39211-3702
(601) 421-3454
(601) 899-3920
Mailing address
5903 RIDGEWOOD RD STE 330, JACKSON, MS 39211-3702
(601) 421-3454
(601) 899-3920
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16155
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0120001
—
MS
Enumeration date
08/06/2009
Last updated
08/06/2009
Update your record
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