Ricky O Tatum, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

002235 Issued in GA

Practice address

306 Isabella St
Waycross, GA 31501-3636

Phone

(912) 285-9990

Fax

(912) 338-8931

NPI assigned

Mar 26, 2010

Last updated

Jan 8, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ware Express Care, LLCGroup PAC ID 1658639075, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ware Express Care, LLC

  • Urgent Care Clinic/Center
  • Waycross, GA
  • NPI 1679083539
  Medicare reassignment Care Compare group
• Orthopaedic Specialists of South Georgia

  • Orthopaedic Surgery Physician
  • Waycross, GA
  • NPI 1912019308
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1269561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767830400000",
    "number": "1073837555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 MARY ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315033823",
            "telephone_number": "912-449-8601",
            "fax_number": "912-449-7060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 ISABELLA ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315013636",
            "telephone_number": "912-285-9990",
            "fax_number": "912-338-8931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATUM",
        "first_name": "RICKY",
        "middle_name": "O",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-26",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "002235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• T Carter LLC
• Betsy Erin Tanner, MSN-FNP, BC
• Holly Tanner
• Laken Renee Tanner, MSPAP, PA-C
• Lindsey Rene Tatum, NP-C
• Alice R Taylor, NP
• Crystal L Taylor, NP
• Leslie C. Taylor, RN, APRN, NP-C
• Shawana Mitchell Taylor, FNP
• Tech Medical Center, LLC (Ela Doc Tree)

• Physician Assistant in Waycross, GA
• Providers in Waycross, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.