Active NPI
Mallory Stephens Tatum, P.A.
- Physician Assistant
- Lakeland, TN
National Provider Identifier
1467978403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 3352
- Practice address
- 9160 Highway 64 Ste 105
Lakeland, TN 38002-3011 - Phone
- (901) 213-0100
- Fax
- (901) 213-0101
- NPI assigned
- Aug 22, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 3352 | TN | Primary |
Addresses
Primary practice location
9160 Highway 64 Ste 105
Lakeland, TN 38002-3011
Mailing address
8016 Ellis Rd
Bartlett, TN 38133-2806
Phone (662) 322-9442
Other practice location 1
100 Baptist Memorial Cir Ste 200
Oxford, MS 38655-4476
Phone (662) 513-3246
Other practice location 2
401 Southcrest Cir Ste 201
Southaven, MS 38671-6721
Phone (901) 226-0456
Other practice location 3
6029 Walnut Grove Rd Ste 305
Memphis, TN 38120-2155
Phone (901) 226-0533
Other practice location 4
7736 Airways Blvd
Southaven, MS 38671-5306
Phone (662) 772-5222
Other practice location 5
255 Baptist Blvd Ste 401
Columbus, MS 39705-2006
Phone (662) 244-2288
Other practice location 6
2301 S LaMar Blvd Ste 140
Oxford, MS 38655-5373
Phone (662) 513-3246
Other practice location 7
2550 Parr Ave
Dyersburg, TN 38024-2033
Phone (731) 325-5678
Other practice location 8
7600 Wolf River Blvd
Ste 200
Germantown, TN 38138
Phone (901) 747-1000
Other practice location 9
2550 Parr Ave
Dyersburg, TN 38024-2033
Phone (731) 325-5678
Other practice location 10
9160 Highway 64 Ste 105
Lakeland, TN 38002-3011
Phone (901) 213-0100
Other names 1
- Mallory Stephens
Organizations & group practices 8
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Emergency Medicine Physician
- Memphis, TN
- NPI 1801677083
TN
-
- Emergency Medicine Physician
- Memphis, TN
- NPI 1609657873
TN
-
- Emergency Medicine Physician
- Memphis, TN
- NPI 1023899291
TN
-
- Diagnostic Radiology Physician
- Germantown, TN
- NPI 1043260763
TN
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170928002449 | TN | Practitioner - Physician Assistant | 0840564506 | Reassigns benefits to 8 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3352 | TN | MD | Professional Counselor |
Interoperability endpoints
- mtatum40522@mlh.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585180800000",
"number": "1467978403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8016 ELLIS RD",
"city": "BARTLETT",
"state": "TN",
"postal_code": "381332806",
"telephone_number": "662-322-9442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9160 HIGHWAY 64 STE 105",
"city": "LAKELAND",
"state": "TN",
"postal_code": "380023011",
"telephone_number": "901-213-0100",
"fax_number": "901-213-0101"
}
],
"practiceLocations": [
{
"address_1": "100 Baptist Memorial Cir Ste 200",
"address_purpose": "LOCATION",
"city": "Oxford",
"state": "MS",
"postal_code": "386554476",
"country_code": "US",
"telephone_number": "662-513-3246",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "401 Southcrest Cir Ste 201",
"address_purpose": "LOCATION",
"city": "Southaven",
"state": "MS",
"postal_code": "386716721",
"country_code": "US",
"telephone_number": "901-226-0456",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6029 Walnut Grove Rd Ste 305",
"address_purpose": "LOCATION",
"city": "Memphis",
"state": "TN",
"postal_code": "381202155",
"country_code": "US",
"telephone_number": "901-226-0533",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7736 Airways Blvd",
"address_purpose": "LOCATION",
"city": "Southaven",
"state": "MS",
"postal_code": "386715306",
"country_code": "US",
"telephone_number": "662-772-5222",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "255 Baptist Blvd Ste 401",
"address_purpose": "LOCATION",
"city": "Columbus",
"state": "MS",
"postal_code": "397052006",
"country_code": "US",
"telephone_number": "662-244-2288",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2301 S LaMar Blvd Ste 140",
"address_purpose": "LOCATION",
"city": "Oxford",
"state": "MS",
"postal_code": "386555373",
"country_code": "US",
"telephone_number": "662-513-3246",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2550 Parr Ave",
"address_purpose": "LOCATION",
"city": "Dyersburg",
"state": "TN",
"postal_code": "380242033",
"country_code": "US",
"telephone_number": "731-325-5678",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7600 Wolf River Blvd",
"address_2": "Ste 200",
"address_purpose": "LOCATION",
"city": "Germantown",
"state": "TN",
"postal_code": "38138",
"country_code": "US",
"telephone_number": "901-747-1000",
"fax_number": "901-747-1001",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2550 Parr Ave",
"address_purpose": "LOCATION",
"city": "Dyersburg",
"state": "TN",
"postal_code": "380242033",
"country_code": "US",
"telephone_number": "731-325-5678",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "9160 Highway 64 Ste 105",
"address_purpose": "LOCATION",
"city": "Lakeland",
"state": "TN",
"postal_code": "380023011",
"country_code": "US",
"telephone_number": "901-213-0100",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TATUM",
"first_name": "MALLORY",
"middle_name": "STEPHENS",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-22",
"last_updated": "2020-03-26",
"certification_date": "2020-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TN",
"license": "3352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MALLORY",
"last_name": "STEPHENS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lakeland, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.