Mercedes R Tatum, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12598 Issued in GA

Practice address

663 Lanier Park Dr
Gainesville, GA 30501-2059

Phone

(678) 450-0202

Fax

(678) 450-0080

NPI assigned

Oct 4, 2024

Sex

Female

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

Philadelphia College of Osteopathic Medicine, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kidney Care Center of Georgia LLCGroup PAC ID 9638200819, 24 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northeast Georgia Medical Center, Inc Hospital, Gainesville, GA, CCN 110029
• Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mtatum73791@direct.acumenmd.com

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.

• Kidney Care Center of Georgia LLC

  • Nephrology Physician
  • Gainesville, GA
  • NPI 1588981187
  Medicare reassignment Care Compare group
• Fresenius Medical Care Kidney Healthcare, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Demorest, GA
  • NPI 1144490889
  NPD (past)
• Renal Care Group Gainesville East, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Gainesville, GA
  • NPI 1386756104
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northeast Georgia Medical Center, Inc.

  • General Acute Care Hospital
  • Gainesville, GA
  • NPI 1427055821
  Care Compare affiliation
• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Cumming, GA
  • NPI 1376574277
  Care Compare affiliation

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

{
    "created_epoch": "1728000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738022400000",
    "number": "1891514162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "663 LANIER PARK DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012059",
            "telephone_number": "678-450-0202",
            "fax_number": "678-450-0080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "663 LANIER PARK DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012059",
            "telephone_number": "678-450-0202",
            "fax_number": "678-450-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATUM",
        "first_name": "MERCEDES",
        "middle_name": "R",
        "name_prefix": "Miss",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-04",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rafael Tapia Jr., MD
• Daniel Charles Tarquinio, D.O.
• Julie Suttles Tate, LMSW
• Jeffrey A. Tatro, MD
• Cheryl Denise Tatum
• Alexis Taylor, ND
• Charlsie Thomas Taylor, PA-C
• Danielle M Taylor, NP
• James Matthew Taylor, MD, MPH
• Jennifer Daughtrey Taylor, SLP

• Physician Assistant in Gainesville, GA
• Providers in Gainesville, 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 28, 2025; 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.